Provider Demographics
NPI:1689416158
Name:EASTERN MOUNTAIN FAMILY & SUPPORT SERVICES INC.
Entity type:Organization
Organization Name:EASTERN MOUNTAIN FAMILY & SUPPORT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-821-6252
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:JEREMIAH
Mailing Address - State:KY
Mailing Address - Zip Code:41826-0082
Mailing Address - Country:US
Mailing Address - Phone:606-233-6336
Mailing Address - Fax:
Practice Address - Street 1:481 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1762
Practice Address - Country:US
Practice Address - Phone:606-233-6336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care