| NPI | 1376899104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY LEE LACKEY Director 919-773-2706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2020-10-23 |