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Organization

MODERN CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. TRINA R SANDUSKY RN (MEMBER)
(502) 523-8044
Entity
Organization

Contact information

Practice address
104 NANCY COX DR, SUITE D, CAMPBELLSVILLE, KY 42718-6834
(270) 465-8508
(270) 465-8504
Mailing address
104 NANCY COX DR, SUITE D, CAMPBELLSVILLE, KY 42718-6834
(270) 465-8508
(270) 465-8504

Taxonomy

Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
311ZA0620X
Adult Care Home Facility
Primary
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100144580
KY
Enumeration date
11/23/2010
Last updated
07/18/2016
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