| NPI | 1144366345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY S CHISHOLM Director 336-887-2402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-041-776) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-08-22 |