Healthcare Provider Details

I. General information

NPI: 1659956225
Provider Name (Legal Business Name): PREFERRED CASE MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 EXECUTIVE DR STE 101
LEXINGTON KY
40505-4871
US

IV. Provider business mailing address

2220 EXECUTIVE DR STE 101
LEXINGTON KY
40505-4871
US

V. Phone/Fax

Practice location:
  • Phone: 859-294-4289
  • Fax: 859-294-4503
Mailing address:
  • Phone: 859-294-4289
  • Fax: 859-294-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DARREN RILE COKE
Title or Position: ADMINISTRATION
Credential:
Phone: 859-294-4289