| NPI | 1598411159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON HAIRSTON Owner 336-202-9333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251B00000X Case Management |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 253Z00000X In Home Supportive Care | |
| 251X00000X Supports Brokerage | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child | |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2026-01-05 |