| Community Living In Kentucky, Llc | |
|
634 N 12th St Murray KY 42071-1651 | |
| (615) 569-1314 | |
| (615) 577-5654 |
| Full Name | Community Living In Kentucky, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 634 N 12th St, Murray, Kentucky |
| Authorized Official Name and Position | Jessica Kirk (REVENUE CYCLE MANAGER) |
| Authorized Official Contact | 6158805782 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Living In Kentucky, Llc Po Box 931142 Atlanta GA 31193-1146 Ph: (615) 696-6761 | Community Living In Kentucky, Llc 634 N 12th St Murray KY 42071-1651 Ph: (615) 569-1314 |
| NPI Number | 1518281419 |
|---|---|
| Provider Enumeration Date | 03/22/2010 |
| Last Update Date | 09/18/2023 |
| Certification Date | 09/18/2023 |
| Medicare PECOS PAC ID | 3375773393 |
|---|---|
| Medicare Enrollment ID | O20140415000309 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518281419 | NPI | - | NPPES |
| 7100125920 | Medicaid | KY | |
| 7100308510 | Medicaid | KY | |
| 7100310590 | Medicaid | KY | |
| 7100309160 | Medicaid | KY | |
| 7100318650 | Medicaid | KY | |
| 117801-000 | Other | KY | OCCUPATIONAL LICENSE |
| 7100234300 | Medicaid | KY |
| Provider Name | Heather H Dausman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497049977 PECOS PAC ID: 7911139316 Enrollment ID: I20140417002048 |
| Provider Name | Sarah Whitledge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871967406 PECOS PAC ID: 2365749850 Enrollment ID: I20160329000514 |
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