| NPI | 1326276890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMMIE EDWARD DAVIS Owner/CEO 910-977-9888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-047-118) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: NC MHL-047-118) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2009-06-23 |