| NPI | 1922497130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS G INGRAM Owner 800-545-9031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: KY BHSO 800153) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 251B00000X Case Management | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2021-10-27 |