| NPI | 1205011012 |
|---|---|
| Former Legal Business Name | LYDIA'S HOME, LLC |
| Entity Type | Organization |
| Authorized Contact | CRYSTAL PRESSLEY Director 336-855-6937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2022-03-23 |