| NPI | 1396029740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NASHEBA KEY-ALLRED Credentialing Specialist 919-865-8632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: NC MHL-098-169) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 311Z00000X Custodial Care Facility | |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2018-09-27 |