| NPI | 1659814903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERNELL M SIMPSON Administrator 336-613-2319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2016-11-18 |