| NPI | 1538012018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MADISON WALLACE Managing Partner 859-630-7760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2026-02-16 |
| Last Update Date | 2026-02-16 |