| NPI | 1669070215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERNON BRYANT Owner 252-813-1939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2020-10-15 |