| NPI | 1073702429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHEEMA YVETTE SHORE Owner 704-701-2582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-080-163) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2007-10-22 |