| NPI | 1023891157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRINCES ANDRETA CARTER Owner 336-825-2603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 310500000X Intermediate Care Facility, Mental Illness |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 253Z00000X In Home Supportive Care | |
| 251C00000X Day Training, Developmentally Disabled Services | |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2023-08-14 |