MEDICARE: KENTUCKY SUPPORT COMMUNITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1578419925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY SUPPORT COMMUNITY LLC

Provider Business Mailing Address
First Line	:	172 VISTA CT
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-5615
Country	:	US
Telephone Number	:	518-704-9678
Fax Number	:

Provider Business Practice Location Address
First Line	:	172 VISTA CT
Second Line	:
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-5615
Country	:	US
Telephone Number	:	518-704-9678
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID NDAGIRO
Credential	:
Telephone Number	:	518-704-9678

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “KENTUCKY SUPPORT COMMUNITY LLC ” Practice Location

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