=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902425515
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMONHEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2020
-----------------------------------------------------
Last Update Date | 11/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1604 LOUISVILLE RD
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40601-3919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-661-1444
-----------------------------------------------------
Fax | 502-661-1555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 55522
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40555-5522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-806-3502
-----------------------------------------------------
Fax | 502-661-1555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER & CEO
-----------------------------------------------------
Name | JOSEPH MASHNI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-806-3502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------