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 |