| NPI | 1336909605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM T GORHAM Agency Director 252-417-6829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2024-04-13 |