| NPI | 1699816140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY JONES CFO 704-986-1522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL-077-006) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-077-006) |
| 251S00000X Community/Behavioral Health | |
| 311Z00000X Custodial Care Facility | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2021-03-31 |