| NPI | 1073032470 |
|---|---|
| Doing Business As | AZALEA WAY |
| Entity Type | Organization |
| Authorized Contact | MARVIN JOHN SHORT Member 864-313-6967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL045-119) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2017-09-18 |