| NPI | 1629547252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISAAC L. JACKSON CEO 910-361-4785 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0801X |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-11-13 |