# COMMUNITY CARE OF KENTUCKY, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COMMUNITY CARE OF KENTUCKY, INC
- **Other names:** kentucky05
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1194103127
- **Legal business name:** COMMUNITY CARE OF KENTUCKY, INC
- **Authorized official:** MANDY HOLLAND (CREDENTIALING MANAGER)
- **Authorized official phone:** (256) 504-3326

## Contact information

- **Practice address:** 3438 TAYLOR BLVD, LOUISVILLE, KY 40215-2648
- **Practice address phone:** (502) 366-4442
- **Practice address fax:** (502) 366-4446
- **Mailing address:** PO BOX 2369, ANNISTON, AL 36202-2369
- **Mailing address phone:** (256) 241-3965
- **Mailing address fax:** (256) 241-1698

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/11/2015
- **Last updated:** 05/11/2015