| NPI | 1417712670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEISHA MILLER Billing Director 704-219-4720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-02-16 |
| Last Update Date | 2024-02-16 |