| NPI | 1164773503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL DIEDRITCH SICKEROTT Owner 919-946-1758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC MHL-092-469) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2012-09-25 |