| NPI | 1063788040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANITTA RENEE BROOKS Owner/Administrator 252-969-1934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Additional Taxonomies | 174H00000X Health Educator |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 385H00000X Respite Care | |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2012-03-23 |