Provider Demographics
NPI:1164706560
Name:COMMONWEALTH CASE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:COMMONWEALTH CASE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-271-3555
Mailing Address - Street 1:199 SILVERDUST CIR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-3821
Mailing Address - Country:US
Mailing Address - Phone:606-340-8108
Mailing Address - Fax:606-679-1234
Practice Address - Street 1:199 SILVERDUST CIR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-3821
Practice Address - Country:US
Practice Address - Phone:606-340-8108
Practice Address - Fax:606-679-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management