Provider Demographics
NPI:1215404082
Name:ONE CROSS COMMUNITY, INC.
Entity Type:Organization
Organization Name:ONE CROSS COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-403-1106
Mailing Address - Street 1:102 WINSTON WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-4991
Mailing Address - Country:US
Mailing Address - Phone:270-789-0034
Mailing Address - Fax:270-789-0097
Practice Address - Street 1:429 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1346
Practice Address - Country:US
Practice Address - Phone:270-789-0034
Practice Address - Fax:270-789-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health