| NPI | 1871613893 |
|---|---|
| Other Name | WTX BACON |
| Entity Type | Organization |
| Authorized Contact | DEENA OMBRES Privacy Officer 502-394-2387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2008-07-02 |