| NPI | 1114450814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGETTE JOHNSON Managing Member 704-460-4072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC HAL-083-019) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2017-04-10 |