| NPI | 1508990094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENSON OTOVO Executive Director 910-485-0085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL026699) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-08-22 |