| NPI | 1659025120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAGLENYA DANTZLER President/Owner 704-658-7507 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2022-02-03 |