| NPI | 1922643287 |
|---|---|
| Doing Business As | KENTUCKY CUSTOM CARE PROFESSIONALS |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY FENWICK Owner 502-331-1085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health |
| 372600000X Adult Companion | |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2019-11-12 |