| NPI | 1144510157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH COY RANDOLPF Owner 252-902-2617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |