| NPI | 1417097221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY EUGENE DAVIS Administrator 704-343-2462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-060-855) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-08-22 |