| NPI | 1558917864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANITHA KURIAN Administrator 336-686-5841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2022-04-01 |