JACOB'S LADDER AT BROOKSIDE FARM, LLC (NPI# 1205344355) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205344355 |
| Entity Type | Organization |
| Organization Name | JACOB'S LADDER AT BROOKSIDE FARM, LLC |
| Practice Address |
25208 George Washington Hwy Aurora WV 26705-8036 |
| Mailing Address |
515 Grand St Morgantown WV 26501-6607 |
| Practice Telephone | 3042391214 |
| Mailing Telephone | 3042900000 |
| Mailing Fax Number | 3042900000 |
| Enumeration Date | 2018-01-10 |
| Last Update Date | 2018-01-10 |
| Authorized Official Name | DR. KEVIN BLANKENSHIP (CEO) |
| Authorized Official Telephone | 3042900000 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
WV | Ambulatory Health Care Facilities |
| Street Address |
25208 GEORGE WASHINGTON HWY |
| City | AURORA |
| State | WV |
| Zip Code | 26705-8036 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225183098 | Union Ambulance Service Inc | Ambulance | 23979 George Washington Hwy, Aurora, WV 26705-8019 | 2007-01-24 |
| 1063022010 | Annie Stemple | Technician | 5065 Maple Spring Hwy, Aurora, WV 26705-8251 | 2020-08-05 |
| 1386251544 | Faith Friend | Technician | 5065 Maple Spring Hwy, Aurora, WV 26705-8251 | 2020-09-30 |
| 1760095574 | Natasha Lynn Goff | Technician | 5531 Lantz Ridge Rd, Aurora, WV 26705-8593 | 2020-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972104636 | Anastasia Canfield | Counselor | 12341 E Cornell Ave # 18, Aurora, CO 80014-3323 | 2020-11-07 |
| 1285235325 | Jean-pierre Fodjouo | Transportation Broker | 19391 E Wyoming Ave, Aurora, CO 80017-5552 | 2020-11-05 |
| 1760083026 | Janani P Iyer | Behavior Technician | 2865 Clara Ave, Aurora, IL 60502-9641 | 2020-11-03 |
| 1740881093 | Lori Lea Samuelson | Specialist | 2481 S Xanadu Way Unit A, Aurora, CO 80014-2141 | 2020-11-03 |
| 1346841871 | Anneisha Elerby | Physical Therapist | 305 W Indian Trl Ste B, Aurora, IL 60506-2473 | 2020-11-02 |
| 1891395455 | Life Wheels On PC | Occupational Therapist | 13450 Smith Rd Ste 600, Aurora, CO 80011-2042 | 2020-10-31 |
| 1407456411 | Nicole Amanda Togun | Case Manager/Care Coordinator | 1290 Chambers Rd Ste 238, Aurora, CO 80011-7117 | 2020-10-28 |
| 1740880806 | Myeyedr Optometry of Colorado PC | Optometrist | 6750 S Cornerstar Way Ste E, Aurora, CO 80016-1573 | 2020-10-28 |
| 1508466855 | Cassandra Elizabeth Saad | Nurse Practitioner | 4024 S Rifle Way, Aurora, CO 80013-3240 | 2020-10-27 |
| 1679173025 | Victoria Williams | Driver | 853 N Highland Ave Ste C, Aurora, IL 60506-2218 | 2020-10-27 |
| Find all providers in AURORA | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467947218 | Lighthouse Recovery Services LLC | Clinic/Center | 11191 E Harvard Dr, Aurora, CO 80014-1708 | 2018-06-25 |
| 1699924183 | Gateway Foundation, Inc. | Clinic/Center | 400 Mercy Ln, Southeast, Aurora, IL 60506-2447 | 2008-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619531894 | Bbc Rehab, PC,inc | Clinic/Center | 2040 Pleasant Valley Rd, Fairmont, WV 26554-9459 | 2019-04-23 |
| 1225592546 | Mercer Hope Connections LLC | Clinic/Center | 484 Pilot St, Princeton, WV 24740-6235 | 2019-01-31 |
| 1437635141 | Lighthouse Community Investment Agency Inc | Clinic/Center | 102 Prichard Street, Williamson, WV 25661 | 2018-07-16 |
| 1043717937 | Serenity Hills Life Center | Clinic/Center | 667 Stone Shannon Rd, Wheeling, WV 26003-6742 | 2018-04-09 |
| 1174022404 | Harmony Ridge Recovery Center, LLC | Clinic/Center | 47 Chambers Circle Drive, Walker, WV 26180 | 2018-02-01 |
| 1841655388 | New Life LLC | Clinic/Center | 130 Pebble Ln, Point Pleasant, WV 25550-4236 | 2015-12-29 |
| 1396756078 | Parkersburg Treatment Center | Clinic/Center | 184 Holiday Hills Drive, Parkersburg, WV 26104-8006 | 2006-08-10 |
| 1770139719 | Village Network | Clinic/Center | 53 14th St Ste 700, Wheeling, WV 26003-3423 | 2019-08-15 |
| 1982180873 | Wv. Family Support and Rehabilitation Services, Inc. | Clinic/Center | 214 E 8th St, Parkersburg, WV 26101-4615 | 2018-07-14 |
| 1184123705 | Harrison County Commission | Clinic/Center | 215 S 3rd St, Clarksburg, WV 26301-0018 | 2018-02-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.