| NPI | 1669173696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE SANDERS Credentialing Manager 502-365-3394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2025-03-13 |