| NPI | 1376130773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE MATTINGLY Provider Enrollment Manager 502-381-3579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3747P1801X Technician Personal Care Attendant |
| Additional Taxonomies | 261QA0600X Clinic/Center Adult Day Care |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2020-12-31 |
| Last Update Date | 2020-12-31 |