Healthcare Provider Details

I. General information

NPI: 1205267671
Provider Name (Legal Business Name): ASSUREDLINK CASE MANAGEMENT AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 LOUISVILLE RD 101
BOWLING GREEN KY
42101-1202
US

IV. Provider business mailing address

1990 LOUISVILLE RD 101
BOWLING GREEN KY
42101-1202
US

V. Phone/Fax

Practice location:
  • Phone: 270-599-0212
  • Fax:
Mailing address:
  • Phone: 270-599-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number7100347620
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberK12245600
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number171431
License Number StateKY

VIII. Authorized Official

Name: MS. DEMETRIUS DEPP KING
Title or Position: OWNER/ EXECUTIVE DIRECTOR
Credential: E.D.
Phone: 270-303-4669