| NPI | 1699820811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS BRADSHAW Executive Director 919-942-7391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-08-22 |