| NPI | 1245883859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN WERNER BOSCO Owner 502-554-8487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2019-07-23 |