| NPI | 1316003668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA E GIBSON Director 910-455-6724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities (Licence: NC MHL067026) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL067026) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2015-06-24 |