| NPI | 1508291683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE GISELLE HINES Office Manager 910-265-0304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL-067-157) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2013-09-10 |