NPIMap

Organization Active NPI

Modern Care LLC

  • Adult Care Home Facility
  • Campbellsville, KY
National Provider Identifier
1659673655
Registry record updated Jul 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
MODERN CARE LLC
Practice address
104 Nancy Cox Dr
Suite D
Campbellsville, KY 42718-6834
Phone
(270) 465-8508
Fax
(270) 465-8504
NPI assigned
Nov 23, 2010
Last updated
Jul 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Trina R Sandusky, RN
Title
Member
Phone
(502) 523-8044

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Custodial Care Facility 311Z00000X
Adult Care Home Facility 311ZA0620X KY Primary

Addresses

Primary practice location

104 Nancy Cox Dr
Suite D
Campbellsville, KY 42718-6834

Mailing address

104 Nancy Cox Dr
Suite D
Campbellsville, KY 42718-6834
Phone (270) 465-8508

Other identifiers 1

IdentifierTypeStateIssuer
7100144580MedicaidKY

National Provider Directory

National Provider Directory
Tax ID family
Modern Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

  • Modern Care LLC
    • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
    • Campbellsville, KY
    • NPI 1922527522
    NPD tax ID

Locations

104 Nancy Cox Dr
Ste D
Campbellsville, KY 42718
Phone (270) 465-8508

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1290470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468800000000",
    "number": "1659673655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 NANCY COX DR",
            "address_2": "SUITE D",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427186834",
            "telephone_number": "270-465-8508",
            "fax_number": "270-465-8504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 NANCY COX DR",
            "address_2": "SUITE D",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427186834",
            "telephone_number": "270-465-8508",
            "fax_number": "270-465-8504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-23",
        "last_updated": "2016-07-18",
        "status": "A",
        "authorized_official_last_name": "SANDUSKY",
        "authorized_official_first_name": "TRINA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "502-523-8044",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "KY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100144580",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Campbellsville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.