| NPI | 1467082156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE MATTINGLY Provider Enrollment Mgr 502-394-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2024-08-15 |