| NPI | 1679975353 |
|---|---|
| Other Name | MCTAVISH HOME |
| Entity Type | Organization |
| Authorized Contact | ERIC MICHAEL PAGE Operations Manager 336-272-8335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-034-329) |
| Additional Taxonomies | 251S00000X (Licence: NC MHL-034-329) |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2018-07-03 |