| NPI | 1013158039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALEBOGO NANZALA SAMUZALA Owner 336-705-0643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2009-03-20 |