Organization
COMMUNITY CARE OF KENTUCKY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD CRUSE (PRESIDENT)
(629) 999-5006
Entity
Organization
Contact information
Practice address
3438 TAYLOR BLVD, LOUISVILLE, KY 40215-2648
(502) 366-4442
(502) 366-4446
Mailing address
3438 TAYLOR BLVD, LOUISVILLE, KY 40215-2648
(502) 366-4442
(502) 366-4446
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50086402
PASSPORT KY
KY
05
—
7100348540
—
KY
Enumeration date
02/02/2015
Last updated
02/04/2016
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