| NPI | 1639219058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J GRAVES Administrator Owner 336-570-2990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC Fcl001064) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2008-02-12 |