| NPI | 1255777256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STELLA KAYE FOWLER Owner/Administrator 336-228-1525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2013-05-16 |