| NPI | 1669121034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ENDRAIN NASH STAFFORD Owner 704-241-1163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2022-03-22 |