| NPI | 1417229113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNADINE SMITH Administrator 757-310-1430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC FCL-072-009) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: NC FCL-072-009) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2012-01-27 |