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Organization
A NEWCO LLC
Active
Organization
A NEWCO LLC
Active
Other names
Kentuckiana Center For Addiction Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE MELVIN COHEN (MEMBER)
(502) 551-2460
Entity
Organization
Contact information
Practice address
1939 GOLDSMITH LN STE 100, LOUISVILLE, KY 40218-3090
(502) 873-7517
(502) 365-2876
Mailing address
9462 BROWNSBORO RD # 357, LOUISVILLE, KY 40241-1118
(502) 873-7517
(502) 365-2876
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001237803
ANTHEM
KY
01
—
2144175
WELLCARE
KY
05
—
7100598570
—
KY
01
—
PDZ000000400708
AETNA BETTER HEALTH
—
Enumeration date
11/23/2018
Last updated
02/12/2025
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