| NPI | 1871228494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA ANN WADDELL Chief Administrative Office 270-839-6743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 276400000X Rehabilitation, Substance Use Disorder Unit |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2022-11-03 |