| NPI | 1467557074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA JEAN SPIGNER Administrator 910-864-1807 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: NC 8301138B) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: NC 3408755) |
| 310400000X Assisted Living Facility (Licence: NC HAL-026-016) | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-026-653) | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-026-272) | |
| 251X00000X Supports Brokerage (Licence: NC 8301138) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2008-06-12 |