| NPI | 1215055215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWANDA JEFFERSON RAY Owner 336-421-0435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC fcl017009) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2008-06-24 |