| NPI | 1528296647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GILDA STEPHENSON Administrator 252-370-8666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2023-09-20 |