| NPI | 1295850519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE L GIBSON President 336-274-1269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2022-06-09 |