| NPI | 1497378111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE MATTINGLY Manager Provider Enrollment 502-381-3579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2020-05-28 |