| NPI | 1831316595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIM DEWAYNE HISLE President 502-428-9037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: KY 7100010990) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| 251C00000X | |
| 261Q00000X | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 261QA0600X Clinic/Center, Adult Day Care (Licence: KY 7100233390) | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: KY 7100199960) | |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2018-07-12 |