| NPI | 1386384022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESHON WISE Owner 919-671-1989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-03-30 |