| NPI | 1376692509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD F. STAPLES Owner 336-635-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-079-083) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-079-080) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2010-09-13 |