Provider Demographics
NPI:1689727224
Name:LOUISVILLE INDEPENDENT CASE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:LOUISVILLE INDEPENDENT CASE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:WARNER
Authorized Official - Last Name:NEWKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-452-9089
Mailing Address - Street 1:8919 STONE GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4073
Mailing Address - Country:US
Mailing Address - Phone:502-452-9089
Mailing Address - Fax:502-495-7840
Practice Address - Street 1:8919 STONE GREEN WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4073
Practice Address - Country:US
Practice Address - Phone:502-452-9089
Practice Address - Fax:502-495-7840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY17000316Medicaid
KY33000589Medicaid