| NPI | 1194954875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE URADU Program Director 606-393-4632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone (Licence: KY KY-10054-M) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: KY 810271) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: KY 40541) | |
| 3336C0002X Pharmacy Clinic Pharmacy (Licence: KY 10054) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2021-08-12 |