Allegiance To Self
Substance Abuse Rehabilitation Facility in Louisville, KY. Organization (NPI-2).
NPI number1679389332
StatusActive
Last updated in NPPESDec 10, 2024
Details
- NPI
- 1679389332
- Entity type
- Organization (NPI-2)
- Legal business name
- Allegiance To Self
- Organization subpart
- No
- Enumeration date
- Dec 9, 2024
- Certification date
- Dec 10, 2024
- Last updated
- Dec 10, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 324500000X | Substance Abuse Rehabilitation Facility | – | – | Yes |
| 101YM0800X | Counselor, Mental Health | – | – | |
| 251B00000X | Case Management | – | – |
Practice location
3711 W BroadwayLouisville, KY 40211-2847
Phone 502-322-2065
Mailing address
9508 Yellow Pine CtLouisville, KY 40229-1642
Phone 502-322-2065
Authorized official
Antwone Shaw
Ceo
5023222065
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