| NPI | 1619096559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI GOUGEON Executive Director 704-536-6661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL 060-160) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2018-03-20 |