| NPI | 1649980046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR SHORT Owner/Executive Director 502-715-8141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2023-04-27 |