| NPI | 1396981676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAN BROWN CANNON CEO 252-799-0300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-058-032) |
| Additional Taxonomies | 251S00000X |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-058-013) | |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2008-12-17 |