| NPI | 1144515032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROUGHTON LEEVANUAL MILES Board Member 336-634-0964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| 261QH0100X Clinic/Center, Health Services | |
| 261QR0800X Clinic/Center, Recovery Care | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2011-06-18 |
| Last Update Date | 2011-06-18 |