Organization
EAST COAST REHABILITATION CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN D FERGUSON IV LCADC (MEMBER)
(606) 369-4617
Entity
Organization
Contact information
Practice address
512 EXECUTIVE PARK, ST MATTHEWS, KY 40207-4205
(502) 415-9289
Mailing address
512 EXECUTIVE PARK, ST MATTHEWS, KY 40207-4205
(502) 415-9289
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
ADCLAD00222794
KY
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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