# A NEWCO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kentuckiana Center For Addiction Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285103937
- **Authorized official:** MR. BRUCE MELVIN COHEN (MEMBER)
- **Authorized official phone:** (502) 551-2460

## Contact information

- **Practice address:** 1939 GOLDSMITH LN STE 100, LOUISVILLE, KY 40218-3090
- **Practice address phone:** (502) 873-7517
- **Practice address fax:** (502) 365-2876
- **Mailing address:** 9462 BROWNSBORO RD \# 357, LOUISVILLE, KY 40241-1118
- **Mailing address phone:** (502) 873-7517
- **Mailing address fax:** (502) 365-2876

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/23/2018
- **Last updated:** 02/12/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000001237803 | ANTHEM | KY |
| 01 | — | 2144175 | WELLCARE | KY |
| 05 | — | 7100598570 | — | KY |
| 01 | — | PDZ000000400708 | AETNA BETTER HEALTH | — |