| Community Care Of Kentucky, Inc. | |
|
2500 W Broadway Ste 100 Louisville KY 40211-1184 | |
| (502) 776-1754 | |
| (502) 778-2301 |
| Full Name | Community Care Of Kentucky, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2500 W Broadway Ste 100, Louisville, Kentucky |
| Authorized Official Name and Position | Jenell Stump (MANAGER, LICENSING & CREDENTIALING) |
| Authorized Official Contact | 6299995006 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Care Of Kentucky, Inc. Po Box 2369 Anniston AL 36202-2369 Ph: (256) 241-3965 | Community Care Of Kentucky, Inc. 2500 W Broadway Ste 100 Louisville KY 40211-1184 Ph: (502) 776-1754 |
| NPI Number | 1811375785 |
|---|---|
| Provider Enumeration Date | 05/12/2015 |
| Last Update Date | 05/07/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811375785 | NPI | - | NPPES |
| 7100298140 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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