# COMMONWEALTH CORRECTIONAL CARE

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

## Provider details

- **NPI number:** 1649060997
- **Authorized official:** MR. BENJAMIN HALE (PRESIDENT)
- **Authorized official phone:** (606) 524-2880

## Contact information

- **Practice address:** 15402 CHAMPION LAKES PL, LOUISVILLE, KY 40245-5601
- **Practice address phone:** (502) 552-3879
- **Mailing address:** 15402 CHAMPION LAKES PL, LOUISVILLE, KY 40245-5601
- **Mailing address phone:** (502) 552-3879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/09/2025
- **Last updated:** 05/09/2025