| NPI | 1629369012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA D. BLACK Administrator 910-574-7239 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-026-911) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2011-04-20 |