Provider Demographics
NPI:1114447679
Name:OUR CARE COMMUNITY SUPPORTS LLC
Entity Type:Organization
Organization Name:OUR CARE COMMUNITY SUPPORTS LLC
Other - Org Name:MY CARE FAMILY COMMUNITY SUPPORT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONTINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-299-1827
Mailing Address - Street 1:5407 GALAXIE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3329
Mailing Address - Country:US
Mailing Address - Phone:502-299-1827
Mailing Address - Fax:502-409-5092
Practice Address - Street 1:1512 CRUMS LN # LN305
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3861
Practice Address - Country:US
Practice Address - Phone:502-299-1827
Practice Address - Fax:502-409-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health