| NPI | 1164708897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHEA VIVIAN ROGERS Director 336-578-0004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2025-04-23 |