| NPI | 1801309885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUDE EDWARDS JOHNSON Owner/Operator 502-794-3082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2022-11-03 |