Provider Demographics
NPI:1306347208
Name:ULTIMATE CARE BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:ULTIMATE CARE BEHAVIORAL HEALTH SERVICES
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:MD
Authorized Official - Phone:606-393-4632
Mailing Address - Street 1:3655 WINCHESTER AVE STE 1
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:SUITE 1
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:2018-02-26
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY800167251S00000X
261QM2800X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone