| NPI | 1568951515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARISSA D PAUL Organizer 336-512-6502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2018-05-05 |
| Last Update Date | 2019-09-12 |