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COMMONWEALTH COMMUNITY CARE CENTERS, LLC

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Company Details

Name: COMMONWEALTH COMMUNITY CARE CENTERS, LLC
Legal type: Kentucky Limited Liability Company
Status: Active
Standing: Good
Profit or Non-Profit: Profit
File Date: 10 Jan 2020 (6 years ago)
Organization Date: 10 Jan 2020 (6 years ago)
Last Annual Report: 14 Apr 2025 (3 months ago)
Managed By: Members
Organization Number: 1083072
Industry: Health Services
Number of Employees: Small (0-19)
ZIP code: 41653
City: Prestonsburg, Emma, Endicott, Hippo
Primary County: Floyd County
Principal Office: 154 NORTH LAKE DRIVE, PRESTONSBURG, KY 41653
Place of Formation: KENTUCKY

Registered Agent

Name Role
JOHN B TACKETT Registered Agent
JAMES ANDERSON Registered Agent

Member

Name Role
TIMOTHY R LAVENDER Member
BENJAMIN DORSEY FERGUSON IV LIVING TRUST Member

Organizer

Name Role
JAMES K ANDERSON Organizer

U.S. Small Business Administration Profile

Phone Number:
E-mail Address:
Fax Number:
606-506-5039
Contact Person:
BENJAMIN FERGUSON
Ownership and Self-Certifications:
Service-Disabled Veteran, Veteran
User ID:
P2960101

Unique Entity ID

Unique Entity ID:
GHS6WK52ZSD3
CAGE Code:
9GY19
UEI Expiration Date:
2026-02-03

Business Information

Activation Date:
2025-02-05
Initial Registration Date:
2023-02-13

National Provider Identifier

NPI Number:
1568094670
Certification Date:
2022-09-02

Authorized Person:

Name:
MRS. YVETTE WISENER
Role:
BILLING
Phone:

Taxonomy:

Selected Taxonomy:
207V00000X - Obstetrics & Gynecology Physician
Is Primary:
No
Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
207NS0135X - Procedural Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
6065065039

Filings

Name File Date
Annual Report 2024-06-28
Registered Agent name/address change 2023-05-11
Annual Report 2023-05-11
Principal Office Address Change 2023-01-17
Annual Report Amendment 2022-09-28

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Sources: Kentucky Secretary of State