| NPI | 1699080705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRELL FRANK JOHNSON Owner 252-200-4218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL064-107) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2010-08-12 |