| NPI | 1093916751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CELESTE INEZ DOMINGUEZ CEO 704-873-2211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2018-07-11 |