| NPI | 1295509230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY LYNN GRAVES-WOODARD CEO 336-514-8252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-11-09 |
| Last Update Date | 2023-11-09 |