| NPI | 1689841769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALESSIA GODWIN Administrator 919-618-3326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2009-03-31 |