| NPI | 1336285337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVIDW W FORSYTHE Executive Director 336-599-9421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 251X00000X Supports Brokerage |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-08-22 |