| NPI | 1053519405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RASHONNA NAKEISHA JOHNSON Administrator 252-268-5912 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2008-06-13 |