| NPI | 1083128508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALPHONSUS E NGWADOM Administrator 919-247-2312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 310400000X Assisted Living Facility | |
| 3104A0625X Assisted Living Facility Assisted Living, Mental Illness | |
| 315P00000X Intermediate Care Facility, Mentally Retarded | |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| 376G00000X Nursing Home Administrator | |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2023-04-02 |