Healthcare Provider Details

I. General information

NPI: 1144492430
Provider Name (Legal Business Name): COONS CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 FERGUSON LN
GEORGETOWN KY
40324-1284
US

IV. Provider business mailing address

117 FERGUSON LN
GEORGETOWN KY
40324-1284
US

V. Phone/Fax

Practice location:
  • Phone: 502-542-7133
  • Fax: 502-370-4521
Mailing address:
  • Phone: 502-542-7133
  • Fax: 502-370-4521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID JOHN COONS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 502-542-7133