| NPI | 1083754410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITTIE B FULLER Administrator Owner 336-684-2282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: NC FCL-001-092) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-08-22 |