| NPI | 1043500572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE D. STATON Owner/Director 252-908-1357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-033-092) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2011-04-18 |