Provider Demographics
NPI:1144637232
Name:ALCOHOL & DRUG ABUSE PREVENTION & TREATMENT SPECIALTIES, LLC
Entity type:Organization
Organization Name:ALCOHOL & DRUG ABUSE PREVENTION & TREATMENT SPECIALTIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCO
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:606-653-1503
Mailing Address - Street 1:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:BETSY LAYNE
Mailing Address - State:KY
Mailing Address - Zip Code:41605
Mailing Address - Country:US
Mailing Address - Phone:606-653-1505
Mailing Address - Fax:
Practice Address - Street 1:4963 US HWY 23 N
Practice Address - Street 2:SUITE 121
Practice Address - City:IVEL
Practice Address - State:KY
Practice Address - Zip Code:41642
Practice Address - Country:US
Practice Address - Phone:606-653-1505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health