| NPI | 1508166729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ANTHONY BENJAMIN Director Owner 336-887-3864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-041-994) |
| Additional Taxonomies | 251S00000X (Licence: NC MHL-041-994) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2011-01-28 |