Healthcare Provider Details

I. General information

NPI: 1750503330
Provider Name (Legal Business Name): WOMACK-CARTER OPTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 STATE ROUTE 121 N
MURRAY KY
42071-7945
US

IV. Provider business mailing address

1305 FARRIS AVE
MURRAY KY
42071-1803
US

V. Phone/Fax

Practice location:
  • Phone: 270-767-1543
  • Fax: 270-767-1545
Mailing address:
  • Phone: 270-767-1543
  • Fax: 270-767-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. BONNIE ANN MCCLURE
Title or Position: CEO
Credential: MSW
Phone: 270-703-2966