| NPI | 1194295089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY DENISE HENDERSHOT Administrator 270-791-9943 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2018-12-13 |