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Organization

JACOB'S LADDER AT BROOKSIDE FARM, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KEVIN BLANKENSHIP MD (CEO)
(304) 290-0000
Entity
Organization

Contact information

Practice address
25208 GEORGE WASHINGTON HWY, AURORA, WV 26705-8036
(304) 239-1214
Mailing address
515 GRAND ST, MORGANTOWN, WV 26501-6607
(304) 290-0000
(304) 290-0000

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
WV

Other

Enumeration date
01/10/2018
Last updated
01/10/2018
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