| NPI | 1871137414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA MARIE VARNER Office Manager 502-239-6739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2019-11-06 |