| NPI | 1215057468 |
|---|---|
| Other Name | EC GBO KONNOAK |
| Entity Type | Organization |
| Authorized Contact | DEENA OMBRES Privacy Officer 502-394-2387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2008-07-28 |