| NPI | 1316718067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA U PROSS CEO 704-963-7552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2024-10-15 |