Provider Demographics
NPI:1194954875
Name:ULTIMATE CARE MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:ULTIMATE CARE MEDICAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:URADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-393-4632
Mailing Address - Street 1:3655 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2065
Mailing Address - Country:US
Mailing Address - Phone:606-393-4632
Mailing Address - Fax:888-411-4131
Practice Address - Street 1:3655 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2065
Practice Address - Country:US
Practice Address - Phone:606-393-4632
Practice Address - Fax:888-411-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY810271101YA0400X
KY40541207QA0401X
KYKY-10054-M261QM2800X
KY100543336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No3336C0002XSuppliersPharmacyClinic PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100090030Medicaid
1832977OtherNCPDP PROVIDER IDENTIFICATION NUMBER