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205 Champion Way Ste 11 Georgetown KY 40324-8862 | |
| (502) 603-0020 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 205 Champion Way Ste 11, Georgetown, Kentucky |
| Authorized Official Name and Position | Jaime Ison Gilbert (CEO) |
| Authorized Official Contact | 8593170802 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1105 Nathaniel Ct Georgetown KY 40324-1069 Ph: (859) 317-0802 | 205 Champion Way Ste 11 Georgetown KY 40324-8862 Ph: (502) 603-0020 |
| NPI Number | 1922632249 |
|---|---|
| Provider Enumeration Date | 02/25/2020 |
| Last Update Date | 01/08/2024 |
| Certification Date | 01/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922632249 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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