| NPI | 1104944081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY KAY BRADSHER Adm. Manager/Owner 336-226-2575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-001-103) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC 753096607) |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-001-141) | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-001-141) | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-001-103) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2013-08-21 |