| NPI | 1639883564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE A CORNELIUS Owner 704-870-9584 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| Enumeration Date | 2023-01-05 |
| Last Update Date | 2023-06-06 |