| NPI | 1558691360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD LEWIS HAIRSTON Owner Operator 919-673-6928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-079-107) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2009-12-30 |