| NPI | 1356469712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STELLA K FOWLER Administrator 336-229-2008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: NC FCL-001-028) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2009-08-04 |