| NPI | 1689930547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK HICKS Owners 336-681-1653 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC mhl-041-1026) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2017-06-26 |