| NPI | 1548449986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA GAIL SOUTHERLAND Executive Director/Medical Biller 910-670-6567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 251B00000X Case Management |
| 251E00000X Home Health | |
| 251S00000X Community/Behavioral Health | |
| 252Y00000X Early Intervention Provider Agency | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 385HR2050X Respite Care Respite Care Camp | |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2007-11-02 |