Healthcare Provider Details

I. General information

NPI: 1134892821
Provider Name (Legal Business Name): COMMONHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 ELM ST
EMINENCE KY
40019-6538
US

IV. Provider business mailing address

PO BOX 55522
LEXINGTON KY
40555-5522
US

V. Phone/Fax

Practice location:
  • Phone: 502-661-1444
  • Fax:
Mailing address:
  • Phone: 502-661-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BASIL MASHNI
Title or Position: OWNER
Credential:
Phone: 859-806-3502