| NPI | 1639337090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL LEWIS CEO/President 336-457-9034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-041-869) |
| Additional Taxonomies | 251S00000X (Licence: NC MHL-041-869) |
| Enumeration Date | 2008-06-01 |
| Last Update Date | 2009-04-24 |