| NPI | 1023595550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD ANTHONY BENJAMIN Owner 336-558-1742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2021-09-03 |