| NPI | 1194854075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE COLEY Billing Assistant 910-483-0734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-08-23 |