| NPI | 1306036223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY CHAMPION Owner 704-434-7727 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2007-07-26 |