JACOB'S LADDER AT BROOKSIDE FARM LLC NPI 1205344355

NPI Information

  • NPI: 1205344355
  • Provider Name: JACOB'S LADDER AT BROOKSIDE FARM, LLC
  • Classification: Clinic/Center - 261QR0405X
  • Specialization: Rehabilitation, Substance Use Disorder
  • Entity Type: Organization
  • CLIA Number: 51D2145661
  • Address: 25208 GEORGE WASHINGTON HWY
    AURORA, WV
    ZIP 26705
  • Phone: (304) 239-1214

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NPI Details

JACOB'S LADDER AT BROOKSIDE FARM, LLC is a rehabilitation and substance use disorder clinic center in Aurora, WV. JACOB'S LADDER AT BROOKSIDE FARM, LLC NPI is 1205344355. The provider is registered as an organization entity type.

The provider's business location address is:

25208 GEORGE WASHINGTON HWY
AURORA, WV
ZIP 26705-036
Phone: (304) 239-1214

The provider's authorized official is Kevin Blankenship .
The authorized official title is Ceo and has the following contact phone number (304) 290-0000.

The CLIA number assigned to this NPI record is 51D2145661 - other - inpatient addiction treat with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/10/2018 and was last updated on 1/10/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR0405XClinic/CenterRehabilitation, Substance Use DisorderWEST VIRGINIAYes

What is NPI?

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This page was last updated on: 11/21/2025

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