| NPI | 1053457523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES E HARDISON Owner 252-946-6245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: NC MHL-007-056) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL-007-056) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2008-07-15 |