| NPI | 1689267858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZZA MAE PHILLIPS Owner 252-314-2530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2021-02-18 |