| NPI | 1316125222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY BENNETT Executive Director 336-456-5349 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2008-06-02 |