| NPI | 1437324902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATHAY COLTRANE CEO 336-669-2819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-041-620) |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2008-04-25 |