Provider Demographics
NPI:1225372303
Name:KENTUCKY CASE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:KENTUCKY CASE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOMIKA
Authorized Official - Middle Name:HOLMES
Authorized Official - Last Name:COSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-263-8338
Mailing Address - Street 1:3715 BARDSTOWN RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2269
Mailing Address - Country:US
Mailing Address - Phone:502-263-8338
Mailing Address - Fax:502-742-8535
Practice Address - Street 1:3715 BARDSTOWN RD STE 210
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2269
Practice Address - Country:US
Practice Address - Phone:502-263-8338
Practice Address - Fax:502-742-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management