| NPI | 1649487745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DASIA PENDLETON Provider Enrollment Specialist 502-630-7494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 385H00000X Respite Care |
| 174400000X Specialist | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2025-11-13 |