| NPI | 1457591356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTOINETTA DEMTRIA FULTON Onwer/ Director 336-230-0808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-041-895) |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2009-03-05 |