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Organization
COMMONWEALTH CORRECTIONAL CARE
Active
Organization
COMMONWEALTH CORRECTIONAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN HALE (PRESIDENT)
(606) 524-2880
Entity
Organization
Contact information
Practice address
15402 CHAMPION LAKES PL, LOUISVILLE, KY 40245-5601
(502) 552-3879
Mailing address
15402 CHAMPION LAKES PL, LOUISVILLE, KY 40245-5601
(502) 552-3879
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/09/2025
Last updated
05/09/2025
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