Provider Demographics
NPI:1932250586
Name:EAST KENTUCKY SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:EAST KENTUCKY SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-633-7272
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:35 REEL VIEW DRIVE
Mailing Address - City:JEREMIAH
Mailing Address - State:KY
Mailing Address - Zip Code:41826-0133
Mailing Address - Country:US
Mailing Address - Phone:606-633-7272
Mailing Address - Fax:
Practice Address - Street 1:35 REEL VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:JEREMIAH
Practice Address - State:KY
Practice Address - Zip Code:41826-0133
Practice Address - Country:US
Practice Address - Phone:606-633-7272
Practice Address - Fax:606-633-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33000829Medicaid