| NPI | 1700264918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN DORSEY FERGUSON Clinical Director/Supervisor 606-506-5077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: KY 810470) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: KY 1361) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2018-03-17 |