| NPI | 1649316639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NASHEBA KEY-ALLRED Credentialing Specialist 919-865-8632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2021-03-09 |