| NPI | 1477646081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JELORE LITTLE Director, Contracts & Credentialing 336-545-6338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child | |
| 251B00000X Case Management | |
| 251C00000X Day Training, Developmentally Disabled Services | |
| 251F00000X Home Infusion | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QH0700X Clinic/Center, Hearing and Speech | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2018-10-04 |