Provider Demographics
NPI:1447710314
Name:ONE CROSS COMMUNITY, INC.
Entity type:Organization
Organization Name:ONE CROSS COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-789-0034
Mailing Address - Street 1:102 WINSTON WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-4991
Mailing Address - Country:US
Mailing Address - Phone:270-789-0034
Mailing Address - Fax:270-789-0097
Practice Address - Street 1:102 WINSTON WAY STE 5
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-4991
Practice Address - Country:US
Practice Address - Phone:270-789-0034
Practice Address - Fax:270-789-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty