| NPI | 1639816796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN C MEBANE Director 336-534-5410 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2022-05-18 |