| NPI | 1245684711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE LATRESIA PEAK MCCLUNEY Administrator 704-406-9721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |