| NPI | 1528107505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTHA WOOTEN SHEPARD Director Owner 910-938-0670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-067-069) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-08-22 |