| NPI | 1124184452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA ELIAZBETH GIBSON Director 910-455-6724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC MHL067131) |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: NC MHL067131) |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL067131) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2018-03-17 |