| NPI | 1194240820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI GOUGEON CEO 704-536-6661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 251S00000X |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2018-03-20 |