| NPI | 1467051631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEVAR LAFAYETTE JACKSON Owner 704-315-7089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 177F00000X Lodging |
| Additional Taxonomies | 261QM1000X Clinic/Center Migrant Health |
| 302R00000X Health Maintenance Organization | |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2020-10-23 |