Healthcare Provider Details

I. General information

NPI: 1700539350
Provider Name (Legal Business Name): DDM CASE MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 04/25/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 MEADOW DRIVE
LOUISVILLE KY
40218-1323
US

IV. Provider business mailing address

2210 MEADOW DRIVE
LOUISVILLE KY
40218-1323
US

V. Phone/Fax

Practice location:
  • Phone: 502-419-8268
  • Fax:
Mailing address:
  • Phone: 502-384-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SPERLISHA VICTORIA AYENI
Title or Position: COMPLIANCE/OPERATIONS OFFICER
Credential:
Phone: 502-384-6009