| NPI | 1164606505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDREY LYNN REDDICK Incorporator 252-327-5149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC 098-051) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2007-12-20 |