| NPI | 1467592436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN LAVERN GRAHAM Administrative Program Director 803-280-9263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL060709) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-24 |