| NPI | 1063470656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE COLEY Billing Supervisor 910-483-0734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2007-12-07 |