| NPI | 1043520513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISHONDA PATRICK Executive Director 336-697-9310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL041903) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2010-10-18 |