# COMMUNITY CARE OF KENTUCKY INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407260052
- **Authorized official:** JENELL STUMP (MANAGER, LICENSING & CREDENTAILING)
- **Authorized official phone:** (629) 999-5006

## 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:** 06/11/2014
- **Last updated:** 05/07/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100298140 | — | KY |