Organization
PHOENIX PREFERRED CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TINA M HAMM (CFO)
(606) 451-9379
Entity
Organization
Contact information
Practice address
201 E MOUNT VERNON ST, SOMERSET, KY 42501-1412
(606) 451-9379
(606) 451-8149
Mailing address
PO BOX 2, SOMERSET, KY 42502-0002
(606) 451-9379
(606) 451-8149
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
069364
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29101847
IMPACT PLUS PROVIDER ID
KY
01
—
29201845
IMPACT PLUS PROVIDER ID
KY
Enumeration date
04/02/2007
Last updated
08/22/2020
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