Organization
MBOKA COMMUNITY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH BASS RN (CO-OWNER)
(502) 671-9908
Entity
Organization
Contact information
Practice address
3514 RAMONA AVE, LOUISVILLE, KY 40220-2411
(502) 671-9908
Mailing address
3514 RAMONA AVE, LOUISVILLE, KY 40220-2411
(502) 671-9908
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
09/14/2023
Last updated
09/14/2023
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