=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801029723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNICARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2009
-----------------------------------------------------
Last Update Date | 07/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1311 N DIXIE HWY
-----------------------------------------------------
City | ELIZABETHTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42701-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-765-5992
-----------------------------------------------------
Fax | 270-737-2293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 CRANES ROOST CT
-----------------------------------------------------
City | ELIZABETHTOWN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42701-3650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-765-2605
-----------------------------------------------------
Fax | 270-234-8572
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LISA WISE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 270-765-2605
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------