| NPI | 1659673655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRINA R SANDUSKY Member 502-523-8044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2016-07-18 |