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General NPI Number Information
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NPI Number | 1164706560
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH CASE MANAGEMENT, LLC
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 199 SILVERDUST CIR
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City | MONTICELLO
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State | KY
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Zip | 42633-3821
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Country | US
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Telephone | 606-340-8108
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Fax | 606-679-1234
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Provider Business Mailing Address
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Address Line | 199 SILVERDUST CIR
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City | MONTICELLO
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State | KY
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Zip | 42633-3821
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Country | US
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Telephone | 606-340-8108
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Fax | 606-679-1234
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | MS. CARRIE SHANNON MCCRACKEN
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Credential |
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Telephone | 606-271-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | KY
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