Healthcare Provider Details

I. General information

NPI: 1720103211
Provider Name (Legal Business Name): MCCLOUD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 CAMPBELLSVILLE ST
COLUMBIA KY
42728-1217
US

IV. Provider business mailing address

113 CAMPBELLSVILLE ST
COLUMBIA KY
42728-1434
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-0560
  • Fax: 270-384-0560
Mailing address:
  • Phone: 270-384-0148
  • Fax: 270-384-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number750172
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELANIE RENA MCCLOUD
Title or Position: ADMINSTRATOR
Credential: R.N.
Phone: 859-537-4579