| NPI | 1275113789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY DENISE MAYNOR Administrator 910-827-9270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2021-04-09 |