Provider Demographics
NPI:1750503330
Name:WOMACK-CARTER OPTIONS, LLC
Entity Type:Organization
Organization Name:WOMACK-CARTER OPTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:270-703-2966
Mailing Address - Street 1:1305 FARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-1803
Mailing Address - Country:US
Mailing Address - Phone:270-767-1543
Mailing Address - Fax:270-767-1545
Practice Address - Street 1:3380 STATE ROUTE 121 N
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-7945
Practice Address - Country:US
Practice Address - Phone:270-767-1543
Practice Address - Fax:270-767-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33000696OtherSCL MEDICAID WAIVER