| NPI | 1255200804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELETE MORELAND CEO 502-804-8003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2025-11-03 |
| Last Update Date | 2025-11-03 |