# HOME AWAY FROM HOME THERAPEUTIC CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548035223
- **Authorized official:** SHAQUILA COOPER DSW, LCSW (OWENER/OPERATOR)
- **Authorized official phone:** (502) 618-9205

## Contact information

- **Practice address:** 849 S 37TH ST, LOUISVILLE, KY 40211-2811
- **Practice address phone:** (502) 618-9204
- **Mailing address:** 1828 BOLLING AVE, LOUISVILLE, KY 40210-1908
- **Mailing address phone:** (502) 618-9205

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 11/22/2023
- **Last updated:** 11/22/2023