| NPI | 1043376387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA ELIZABETH GIBSON Director 910-455-6724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL067144) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-08-22 |