| NPI | 1639313943 |
|---|---|
| Doing Business As | KONNOAK DRIVE GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | ANGIE MATTINGLY Mgr Provider Enrollment 502-630-7425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2022-02-21 |