| NPI | 1164048120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA JOHNSON HAZEL Office Manager 704-476-0625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2020-06-24 |