Provider Demographics
NPI: | 1518281419 |
---|---|
Name: | COMMUNITY LIVING IN KENTUCKY, LLC |
Entity Type: | Organization |
Organization Name: | COMMUNITY LIVING IN KENTUCKY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | REVENUE CYCLE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JESSICA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KIRK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-880-5782 |
Mailing Address - Street 1: | PO BOX 931142 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 31193-1146 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-696-6761 |
Mailing Address - Fax: | 615-880-5782 |
Practice Address - Street 1: | 634 N 12TH ST |
Practice Address - Street 2: | |
Practice Address - City: | MURRAY |
Practice Address - State: | KY |
Practice Address - Zip Code: | 42071-1651 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-569-1314 |
Practice Address - Fax: | 615-577-5654 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-03-22 |
Last Update Date: | 2023-09-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 103K00000X, 103T00000X, 1041C0700X, 106H00000X, 224Z00000X, 225100000X, 225200000X, 225C00000X, 225X00000X, 2355S0801X, 235Z00000X, 251S00000X, 253Z00000X | ||
KY | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225C00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 253Z00000X | Agencies | In Home Supportive Care | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100125920 | Medicaid | |
KY | 7100308510 | Medicaid | |
KY | 7100310590 | Medicaid | |
KY | 7100309160 | Medicaid | |
KY | 7100318650 | Medicaid | |
KY | 117801-000 | Other | OCCUPATIONAL LICENSE |
KY | 7100234300 | Medicaid |