| NPI | 1124157730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE GAGE Executive Director 252-566-8455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-040-036) |
| Additional Taxonomies | 251B00000X Case Management (Licence: NC MHL-040-036) |
| 251C00000X Day Training, Developmentally Disabled Services (Licence: NC MHL-040-036) | |
| 261QA0005X Clinic/Center Ambulatory Family Planning Facility (Licence: NC MHL-040-036) | |
| 3104A0625X Assisted Living Facility Assisted Living, Mental Illness (Licence: NC MHL-040-036) | |
| 311Z00000X Custodial Care Facility (Licence: NC MHL-040-036) | |
| 315P00000X Intermediate Care Facility, Mentally Retarded (Licence: NC MHL-040-036) | |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL-040-036) | |
| 320700000X Residential Treatment Facility, Physical Disabilities (Licence: NC MHL-040-036) | |
| 332900000X Non-Pharmacy Dispensing Site (Licence: NC MHL-040-036) | |
| 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: NC MHL-040-036) | |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: NC MHL-040-036) | |
| 347C00000X Private Vehicle (Licence: NC MHL-040-036) | |
| 385H00000X Respite Care (Licence: NC MHL-040-036) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2007-09-01 |