Healthcare Provider Details

I. General information

NPI: 1013054451
Provider Name (Legal Business Name): COMMUNICARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/25/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 WORKSHOP LN
LEBANON KY
40033-1000
US

IV. Provider business mailing address

107 CRANES ROOST CT
ELIZABETHTOWN KY
42701-3650
US

V. Phone/Fax

Practice location:
  • Phone: 270-692-2509
  • Fax: 270-234-8572
Mailing address:
  • Phone: 270-765-2605
  • Fax: 270-234-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number800005
License Number StateKY

VIII. Authorized Official

Name: LISA WISE
Title or Position: CEO
Credential:
Phone: 270-765-2605