| NPI | 1437969128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVA MILES Consultant 336-513-3499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility |
| Additional Taxonomies | 174200000X Meals |
| 177F00000X Lodging | |
| 251S00000X Community/Behavioral Health | |
| 253Z00000X In Home Supportive Care | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2025-06-11 |