| NPI | 1508996059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICE SMITH CEO 910-323-1817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded (Licence: NC MHL-063-017) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: NC MHL-063-017) |
| 310500000X Intermediate Care Facility, Mental Illness (Licence: NC MHL-063-017) | |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL-063-017) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2012-01-11 |