| NPI | 1497524987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IESHA WALLACE Secretary 704-390-2887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2023-12-26 |
| Last Update Date | 2023-12-26 |