| NPI | 1205693793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEIGH R DAVIS Owner 910-229-5203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 310500000X Intermediate Care Facility, Mental Illness |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2024-03-01 |