| NPI | 1629108097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE COLEY Billing Specialist 910-483-0734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL-026-049) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: NC MHL-026-049) |
| 313M00000X Nursing Facility/Intermediate Care Facility (Licence: NC MHL-026-049) | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-026-049) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2012-01-23 |