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Organization

KENTUCKY CUSTOM CARE PROFESSIONALS

Active
Other names
Kentucky Custom Care Professionals
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY FENWICK CPA (OWNER)
(502) 331-1085
Entity
Organization

Contact information

Practice address
3200 PATTON RD, BOSTON, KY 40107-8700
(502) 331-1085
Mailing address
3200 PATTON RD, BOSTON, KY 40107-8700
(502) 331-1085

Taxonomy

Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
311Z00000X
Custodial Care Facility
Primary
372600000X
Adult Companion

Other

Enumeration date
11/11/2019
Last updated
11/12/2019
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