| NPI | 1376962621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM FLORENE FULTZ L PT A 336-307-6056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: NC 2870) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2014-04-15 |