| NPI | 1043332240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY WHOBREY Provider Enrollment 502-630-7249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2021-02-02 |