| NPI | 1396936464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINGER POPE Administrator 704-855-0004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-080-165) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2021-06-11 |