| NPI | 1962099051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE MATTINGLY Mgr Provider Enrollment 502-381-3579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| 261QA0600X Clinic/Center, Adult Day Care | |
| Enumeration Date | 2020-12-23 |
| Last Update Date | 2020-12-23 |