| NPI | 1689749889 |
|---|---|
| Doing Business As | A. JACK WALL GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | DAWN HARWOOD ALLEN CEO 704-982-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL084017) |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL084017) |
| 323P00000X Psychiatric Residential Treatment Facility (Licence: NC MHL084017) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2015-07-15 |