| NPI | 1477177111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY BLACK Member Manager/Owner 704-239-2199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2020-05-28 |