| Assuredlink Case Management | |
|
1990 Louisville Rd Ste 101 Bowling Green KY 42101-1202 | |
| (270) 303-4669 | |
| Not Available |
| Full Name | Assuredlink Case Management |
|---|---|
| Speciality | Exclusive Provider Organization |
| Location | 1990 Louisville Rd Ste 101, Bowling Green, Kentucky |
| Authorized Official Name and Position | Demetrius King (THERAPIST/OWNER) |
| Authorized Official Contact | 2703034669 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Assuredlink Case Management 1990 Louisville Rd Ste 101 Bowling Green KY 42101-1202 Ph: (270) 303-4669 | Assuredlink Case Management 1990 Louisville Rd Ste 101 Bowling Green KY 42101-1202 Ph: (270) 303-4669 |
| NPI Number | 1336686062 |
|---|---|
| Provider Enumeration Date | 01/19/2017 |
| Last Update Date | 03/02/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336686062 | NPI | - | NPPES |
| 1336686062 | Medicaid | KY | |
| 1205267671 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 171431 (Kentucky) | Secondary |
| 302F00000X | Exclusive Provider Organization | 171431 (Kentucky) | Primary |
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