| NPI | 1639674765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC MICHAEL PAGE Operations Manager 336-272-8335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-076-129) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-076-129) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2018-03-29 |