| NPI | 1871232322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB BOSTON CEO 502-999-7151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261Q00000X | |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2022-06-02 |