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General NPI Number Information
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NPI Number | 1215404082
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Entity Type | Organization
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Legal Business Name | ONE CROSS COMMUNITY, INC.
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 429 W WALNUT ST
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City | LEBANON
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State | KY
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Zip | 40033-1346
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Country | US
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Telephone | 270-789-0034
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Fax | 270-789-0097
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Provider Business Mailing Address
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Address Line | 102 WINSTON WAY STE 5
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-4991
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Country | US
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Telephone | 270-789-0034
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Fax | 270-789-0097
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Authorized Official
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Title or Position | CEO
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Name | KIMBERLY ROSE MCKENNA
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Credential |
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Telephone | 270-403-1106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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