Organization
COMMUNITY CARE OF KENTUCKY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENELL STUMP (MANAGER, LICENSING & CREDENTIALING)
(629) 999-5006
Entity
Organization
Contact information
Practice address
1175 S MAIN ST STE 4, MADISONVILLE, KY 42431-3337
(270) 383-5511
(270) 821-9602
Mailing address
PO BOX 2369, ANNISTON, AL 36202-2369
(256) 741-7340
(256) 741-7373
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100298140
—
KY
Enumeration date
05/11/2015
Last updated
05/07/2018
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