| NPI | 1043580061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY B. TYREE Owner 336-350-1441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC FCL-001-142) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2024-03-12 |