| NPI | 1356492425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY BULLOCK Administrator 919-682-9392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded (Licence: NC MHL-032-049) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-08-22 |