| NPI | 1336312784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE BROBBEY Admin.Manager 336-375-5286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL-041-861) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: NC MHL-041-861) |
| 305R00000X Preferred Provider Organization (Licence: NC MHL-041-861) | |
| 305S00000X Point of Service (Licence: NC MHL-041-861) | |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2008-04-07 |