| NPI | 1699333203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA COSBY Owner 704-953-6259 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2021-03-31 |