| NPI | 1770102089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN DAVENPORT Owner 859-620-2526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2026-06-04 |