| NPI | 1346661949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KWANE MITCHELL WATSON Owner 502-523-2347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X |
| Enumeration Date | 2013-12-27 |
| Last Update Date | 2013-12-27 |