| NPI | 1114110491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN DIANE PERRY Director 252-243-7174 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-098050) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-12-11 |