| NPI | 1245006428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAN COSTELLA HOLLOWAY Owner 252-286-9927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2023-11-29 |