NPI | 1972129591 |
---|---|
Entity Type | Organization |
Authorized Contact | JACQUELINE SANDERS Credentialing Administrator 502-630-2036 |
Organization Subpart ? | No |
Primary Taxonomy | 251S00000X Community/Behavioral Health |
Enumeration Date | 2020-06-19 |
Last Update Date | 2020-06-19 |