| NPI | 1578205548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE MATTINGLY Manager Provider Enrollment 502-630-7425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2022-09-19 |