| NPI | 1467228072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMICO GRAHAM Owner/Cco 704-957-1364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2024-01-22 |