| NPI | 1043561764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK MARCELLOUS PHILLIPS Executive Director/CEO 704-392-9220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL-060-231) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2012-09-20 |