| NPI | 1902628662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE D SANDERS Credentialing Admin 502-616-7276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2024-10-24 |
| Last Update Date | 2024-10-24 |