| NPI | 1376086876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL ANTHONY SAMUELS Owner 336-303-9020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2016-12-01 |
| Last Update Date | 2016-12-01 |