| NPI | 1558499699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE KENTON ISLEY Administrator Owner 336-629-2067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL076073) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-22 |