| NPI | 1942472550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY SHREVE GIBSON Owner 502-352-1443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: KY 279077) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2008-03-24 |