| NPI | 1164757894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD BROADNAX Director 336-451-0571 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385H00000X Respite Care | |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2009-10-14 |