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
2500 W BROADWAY STE 100, LOUISVILLE, KY 40211-1184
(502) 776-1754
(502) 778-2301
Mailing address
PO BOX 2369, ANNISTON, AL 36202-2369
(256) 241-3965
(256) 241-1698
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
05/12/2015
Last updated
05/07/2018
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