| NPI | 1225613706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHON DIONTE WILKERSON Owner 336-470-1712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385H00000X Respite Care | |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2021-03-16 |