| NPI | 1083747828 |
|---|---|
| Other Name | FULL POTENTIAL AT PEMBROKE |
| Entity Type | Organization |
| Authorized Contact | JEROME JOHNSON Director 910-670-1989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-078-188) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-08-22 |