| NPI | 1194153544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODNEY ANTONIO EDWARDS Executive Director 336-887-9504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2013-10-23 |