| NPI | 1295330397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHANI MOHAN VUPADHYAYULA Managing Agent 704-989-5736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2020-12-04 |