| NPI | 1063764702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK MARCELLOUS PHILLIPS Executive Director/CEO 704-392-9220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL-060-514) |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2013-01-10 |