| NPI | 1245018118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI MANESS Controller 704-986-1523 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2025-09-24 |