Organization
MAHOGHANY TREE ROOTED RESOURCES
Active
Organization
MAHOGHANY TREE ROOTED RESOURCES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NASIRA MAH-JABEEN (CREDENTIALING AGENT)
(502) 579-0170
Entity
Organization
Contact information
Practice address
4059 LA SALLE AVE, LOUISVILLE, KY 40215-1321
(502) 579-0170
Mailing address
642 CECIL AVE, LOUISVILLE, KY 40211-3162
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/22/2023
Last updated
09/22/2023
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