| NPI | 1881291672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SPERLISHA VICTORIA AYENI Chief Operations Officer 270-572-4132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2021-02-05 |