| NPI | 1568508190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY E GRIMES Program Billing & Reimb Supervisor 025-265-8389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: KY 100450) |
| Additional Taxonomies | 310500000X Intermediate Care Facility, Mental Illness (Licence: KY 101120) |
| 313M00000X Nursing Facility/Intermediate Care Facility (Licence: KY 101119) | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-12-21 |