| Community Addiction Recovery Llc | |
|
436 South Main St Stanton KY 40380-2189 | |
| (606) 663-7597 | |
| (606) 663-7652 |
| Full Name | Community Addiction Recovery Llc |
|---|---|
| Speciality | Preventive Medicine |
| Location | 436 South Main St, Stanton, Kentucky |
| Authorized Official Name and Position | Taufik Kassis (OWNER) |
| Authorized Official Contact | 6066637597 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Addiction Recovery Llc Po Box 1029 Stanton KY 40380-1029 Ph: (606) 663-7597 | Community Addiction Recovery Llc 436 South Main St Stanton KY 40380-2189 Ph: (606) 663-7597 |
| NPI Number | 1356022693 |
|---|---|
| Provider Enumeration Date | 07/28/2023 |
| Last Update Date | 08/18/2023 |
| Certification Date | 08/18/2023 |
| Medicare PECOS PAC ID | 9032573787 |
|---|---|
| Medicare Enrollment ID | O20230913002301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356022693 | NPI | - | NPPES |
| Provider Name | Taufik E Kassis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174545628 PECOS PAC ID: 2264408608 Enrollment ID: I20040907001014 |
| Provider Name | Jessica Dawn Sparks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760059497 PECOS PAC ID: 8628470937 Enrollment ID: I20210708003580 |
| Provider Name | Ashley Nicole Vanhoose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972259356 PECOS PAC ID: 2769856095 Enrollment ID: I20230822000681 |
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