Organization
MODERN CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY JEWELL (PROGRAM DIRECTOR)
(270) 465-8508
Entity
Organization
Contact information
Practice address
104 NANCY COX DR STE D, CAMPBELLSVILLE, KY 42718-6835
(270) 465-8508
(270) 465-8504
Mailing address
104 NANCY COX DR STE D, CAMPBELLSVILLE, KY 42718-6835
(270) 465-8508
(270) 465-8504
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100144580
—
KY
Enumeration date
09/14/2017
Last updated
07/21/2022
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