| NPI | 1144760844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAWANA SALES Owner/CEO 252-341-1082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2017-02-28 |