| NPI | 1174660021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LONNIE JAMES TUCKER Owner. 704-734-1040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-023-094) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-08-22 |