Provider Demographics
NPI:1124247200
Name:PROMISE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:PROMISE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-439-3465
Mailing Address - Street 1:207 16TH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7909
Mailing Address - Country:US
Mailing Address - Phone:866-439-3465
Mailing Address - Fax:866-731-7460
Practice Address - Street 1:207 16TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7909
Practice Address - Country:US
Practice Address - Phone:866-439-3465
Practice Address - Fax:866-731-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100004560Medicaid
KY5939250001Medicare NSC