| NPI | 1679153571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KESHEA LANELL MONTGOMERY CEO 336-505-9605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility |
| Additional Taxonomies | 251B00000X Case Management |
| 251E00000X Home Health | |
| 251S00000X Community/Behavioral Health | |
| 253Z00000X In Home Supportive Care | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-11-30 |