| NPI | 1134599590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN COMMEDO MORAVIAN Owner 336-554-3486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC 041-1025) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2015-09-29 |