| NPI | 1154470995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE A CLARK Executive Director 606-679-9009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 261QH0700X Clinic/Center Hearing and Speech (Licence: KY 140341) |
| 261QM1300X Clinic/Center Multi-Specialty (Licence: KY 720397) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2016-08-30 |