| NPI | 1689078883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMAAL LEE LEATHERS Administrator 919-423-9236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC FCL-032-132) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: NC FCL-032-132) |
| Enumeration Date | 2014-10-16 |
| Last Update Date | 2014-10-16 |