Organization
JACOB'S LADDER AT BROOKSIDE FARM, LLC
Active
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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