| NPI | 1114291879 |
|---|---|
| Doing Business As | COMMUNITY BASED INTERVENTIONS |
| Doing Business As | OTTER CREEK |
| Entity Type | Organization |
| Authorized Contact | SAMANTHA ANN SIMMONS Director 606-343-0216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: KY 500595) |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: KY 500595) |
| 261Q00000X Clinic/Center | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2021-05-14 |