| NPI | 1427292200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL ALLEN WADE Administrator 336-280-0512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: NC FCL-001-130) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2009-04-24 |