| NPI | 1093319170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOI JACKSON Owner 704-965-7210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251C00000X |
| 311Z00000X Custodial Care Facility | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2021-08-27 |