| NPI | 1114246253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODY MATTHEW THOMAS It Director 704-644-4351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2019-01-03 |