NPI | 1194300806 |
---|---|
Entity Type | Organization |
Authorized Contact | LORI A GOUGEON President 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 | 2021-03-15 |
Last Update Date | 2021-03-15 |