| NPI | 1235721937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAZEL FORMAN Administrator/Owner 336-860-4060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2021-07-06 |