| NPI | 1497625263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SWANNIE JETT CEO 502-774-4401 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-11-07 |
| Last Update Date | 2025-11-07 |