Kentucky Custom Care Professionals

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

KENTUCKY CUSTOM CARE PROFESSIONALS

Practice address

3200 Patton Rd
Boston, KY 40107-8700

Phone

(502) 331-1085

NPI assigned

Nov 11, 2019

Organization subpart

No

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

Authorized official

Name

Kimberly Fenwick, CPA

Title

Owner

Phone

(502) 331-1085

Specialties & licenses 3

Addresses

Other names 1

• Kentucky Custom Care Professionals Doing business as

Tax ID family

Kentucky Custom Care Professionals2 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.

• Kentucky Custom Care Professionals

  • Custodial Care Facility
  • Boston, KY
  • NPI 1639714843
  NPD tax ID

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573516800000",
    "number": "1922643287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 PATTON RD",
            "city": "BOSTON",
            "state": "KY",
            "postal_code": "401078700",
            "telephone_number": "502-331-1085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 PATTON RD",
            "city": "BOSTON",
            "state": "KY",
            "postal_code": "401078700",
            "telephone_number": "502-331-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY CUSTOM CARE PROFESSIONALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-11",
        "last_updated": "2019-11-12",
        "status": "A",
        "authorized_official_last_name": "FENWICK",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-331-1085",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "372600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kentucky Custom Care Professionals",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kentucky Custom Care Professionals",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Blessed Assurance Community Services LLC
• Blessed Assurance Community Services, LLC
• Elizabeth Michelle Crowe, PMHNP-BC
• Barbara Jozwiak, DPT
• Kentucky Custom Care Professionals
• Jessie Smith

• All providers in Boston, KY
• Custodial Care Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; 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.