OrganizationLouisville Independent Case Management, LlcResidential Treatment Facility, Mental Retardation and/or Developmental DisabilitiesResidential Treatment FacilitiesPractice Address8919 Stone Green Way, Louisville, KY 40220-4073(502) 452-9089PECOS EnrollmentBased on the most recent information from CMS, provider Louisville Independent Case Management, Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 9:15 AM.Profile DetailsProvider ID1689727224Provider TypeOrganizationFull NameLouisville Independent Case Management, LlcSubpartNoEnumeration Date1/18/2007Last Updated7/23/2010Contact InformationPractice LocationPractice Address8919 Stone Green Way, Louisville, KY 40220-4073Phone(502) 452-9089Fax(502) 495-7840Mailing LocationMailing Address8919 Stone Green Way, Louisville, KY 40220-4073Phone(502) 452-9089Fax(502) 495-7840Authorized OfficialNameNewkirk, Amy Warner (Executive Director)Phone(502) 452-9089Provider TaxonomiesCodeDescriptionLicenseCode320600000XPrimaryDescriptionResidential Treatment Facility, Mental Retardation and/or Developmental DisabilitiesResidential Treatment FacilitiesLicenseUnlisted IssuerCode251B00000XDescriptionCase ManagementAgenciesLicenseUnlisted IssuerCode251C00000XDescriptionDay Training, Developmentally Disabled ServicesAgenciesLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID17000316DescriptionMedicaidIssuerUnlistedKentuckyID33000589DescriptionMedicaidIssuerUnlistedKentucky