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General NPI Number Information
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NPI Number | 1114447679
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Entity Type | Organization
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Legal Business Name | OUR CARE COMMUNITY SUPPORTS LLC
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1512 CRUMS LN # LN305
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City | LOUISVILLE
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State | KY
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Zip | 40216-3861
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Country | US
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Telephone | 502-299-1827
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Fax | 502-409-5092
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Provider Business Mailing Address
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Address Line | 5407 GALAXIE DR
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City | LOUISVILLE
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State | KY
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Zip | 40258-3329
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Country | US
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Telephone | 502-299-1827
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Fax | 502-409-5092
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Authorized Official
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Title or Position | OWNER
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Name | CONTINA A MCCLAIN
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Credential | APRN
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Telephone | 502-299-1827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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