| NPI | 1063747319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON CHILDRESS Chief Clinical Officer 704-825-4161 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-036-112) | |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2017-08-30 |