Active NPI
Modern Care LLC
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Campbellsville, KY
National Provider Identifier
1922527522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Legal business name
- MODERN CARE LLC
- Practice address
- 104 Nancy Cox Dr Ste D
Campbellsville, KY 42718-6835 - Phone
- (270) 465-8508
- Fax
- (270) 465-8504
- NPI assigned
- Sep 14, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Stacey Jewell
- Title
- Program Director
- Phone
- (270) 465-8508
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Primary |
Addresses
Primary practice location
104 Nancy Cox Dr Ste D
Campbellsville, KY 42718-6835
Mailing address
104 Nancy Cox Dr Ste D
Campbellsville, KY 42718-6835
Phone (270) 465-8508
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100144580 | Medicaid | KY |
National Provider Directory
National Provider Directory- Tax ID family
- Modern Care LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Adult Care Home Facility
- Campbellsville, KY
- NPI 1659673655
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.
-
- Occupational Therapist
- Campbellsville, KY
- NPI 1598494486
-
- Physical Therapist
- Campbellsville, KY
- NPI 1528797321
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505347200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1922527522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 NANCY COX DR STE D",
"city": "CAMPBELLSVILLE",
"state": "KY",
"postal_code": "427186835",
"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 STE D",
"city": "CAMPBELLSVILLE",
"state": "KY",
"postal_code": "427186835",
"telephone_number": "270-465-8508",
"fax_number": "270-465-8504"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MODERN CARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-09-14",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "JEWELL",
"authorized_official_first_name": "STACEY",
"authorized_official_title_or_position": "PROGRAM DIRECTOR",
"authorized_official_telephone_number": "270-465-8508"
},
"taxonomies": [
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": null,
"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 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.