| NPI | 1497968762 |
|---|---|
| Other Name | COUNTRY PINES #1 |
| Entity Type | Organization |
| Authorized Contact | KENNETH MICHAEL SAULS Vice President 919-778-4009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL096117) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL096117) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-09-04 |