| NPI | 1689932865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAYNARD RUSSELL Director 336-672-0169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC MHL-076-108) |
| Additional Taxonomies | 275N00000X Medicare Defined Swing Bed Unit |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL-076-108) | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2022-07-21 |