| NPI | 1487784542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTIE DAVIS Owner 336-275-0627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC FCL-041-007) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2016-10-27 |