| NPI | 1073962874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY E. BROWN Licensed Counselor 606-505-8649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: KY 103105) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: KY 103105) |
| 305S00000X Point of Service (Licence: KY 103105) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2016-06-13 |