| NPI | 1386816882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMAYA CAMPBELL Administrator 704-301-2079 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 974) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |