MEDICARE: DDM CASE MANAGEMENT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700539350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DDM CASE MANAGEMENT SERVICES LLC

Provider Business Mailing Address
First Line	:	2210 MEADOW DRIVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1323
Country	:	US
Telephone Number	:	502-384-6009
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 MEADOW DRIVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1323
Country	:	US
Telephone Number	:	502-419-8268
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE/OPERATIONS OFFICER
Name	:	MS. SPERLISHA VICTORIA AYENI
Credential	:
Telephone Number	:	502-384-6009

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	04/25/2023

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Directions to “DDM CASE MANAGEMENT SERVICES LLC ” Practice Location

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