| NPI | 1184765406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORIS MCKETHAN Owner 910-483-6584 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-026-790) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2020-08-22 |