# COMMUNITY CARE OF KENTUCKY, INC

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

## Provider details

- **NPI number:** 1962880997
- **Authorized official:** JENELL STUMP (MANAGER, LICENSING & CREDENTIALING)
- **Authorized official phone:** (270) 383-5511

## Contact information

- **Practice address:** 122 S LEE TROVER TODD JR HWY, EARLINGTON, KY 42410-1557
- **Practice address phone:** (270) 383-5511
- **Mailing address:** PO BOX 2369, ANNISTON, AL 36202-2369
- **Mailing address phone:** (256) 741-7340

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/11/2015
- **Last updated:** 01/15/2016