| NPI | 1659636173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARICKEYO SENTWAN HUSKEY Administrator 704-600-6710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2012-07-10 |