Provider Demographics
NPI:1528184108
Name:CHRISTIAN CARE COMMUNITIES, INC.
Entity Type:Organization
Organization Name:CHRISTIAN CARE COMMUNITIES, INC.
Other - Org Name:COMMUNITY YOUTH HOME - WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:W
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-4200
Mailing Address - Street 1:12700 SHELBYVILLE RD
Mailing Address - Street 2:THE CUMBERLAND BUILDING
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1151 PERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1306
Practice Address - Country:US
Practice Address - Phone:859-236-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04000014323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY04000014Medicaid