| NPI | 1114073814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY S CHISHOLM Director 336-887-2402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2020-08-22 |