| NPI | 1366570285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNE GIBSON Owner 910-423-8816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC 320900000X) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-22 |