| NPI | 1396302980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE SANDERS Credentialing Administrator 502-630-2036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2019-05-20 |