| NPI | 1104995182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERTRENIA SHANICKA JONES Owner 704-807-5910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC 060-1002) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC 060-1002) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-08-22 |