| NPI | 1386376937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE MATTINGLY Manager Provider Enrollment 502-630-7425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2022-06-30 |