| NPI | 1194480087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARNOLD LEROY GAINES Owner 336-601-1967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2022-06-15 |