| NPI | 1023415692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE STEPHENS Executive Director 502-633-1315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: KY KY-0060) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: KY 1519) |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2014-11-26 |