Healthcare Provider Details

I. General information

NPI: 1902425515
Provider Name (Legal Business Name): COMMONHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 LOUISVILLE RD
FRANKFORT KY
40601-3919
US

IV. Provider business mailing address

PO BOX 55522
LEXINGTON KY
40555-5522
US

V. Phone/Fax

Practice location:
  • Phone: 502-661-1444
  • Fax: 502-661-1555
Mailing address:
  • Phone: 859-806-3502
  • Fax: 502-661-1555

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 MASHNI
Title or Position: FOUNDER & CEO
Credential:
Phone: 859-806-3502