| NPI | 1033839568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENYATTA NECOLE DAVIS Owner 336-340-6399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2022-09-02 |