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COMMONWEALTH COMMUNITY CARE CENTERS, LLC

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 (5 years ago)
Organization Date: 10 Jan 2020 (5 years ago)
Last Annual Report: 14 Apr 2025 (2 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

The U.S. Small Business Administration (SBA) helps Americans start, grow, and build resilient businesses.

Note: SBA was created in 1953 as an independent agency of the federal government to aid, counsel, assist and protect the interests of small business concerns; preserve free competitive enterprise; and maintain and strengthen the overall economy of our nation. SBA reviews Congressional and testifies on behalf of small businesses. It assesses the impact of regulatory burden on small businesses.

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

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

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

Sources: Kentucky Secretary of State