| NPI | 1104005735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLIVER FORD Owner/President 910-381-0125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NC MHL 067-167) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2009-09-14 |