=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043086127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LATINO CASE MANAGEMENT, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2023
-----------------------------------------------------
Last Update Date | 11/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 710 MOUNT EDEN RD
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40065-8820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-437-0053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5511 FERN BROOK LN
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40291-1928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-216-0553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | CLARENA WRIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-216-0553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------