| NPI | 1396924221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY AUGUSTUS LUTTERODT Executive Director 336-510-6966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-10-27 |
| Last Update Date | 2007-10-27 |