| NPI | 1699850891 |
|---|---|
| Doing Business As | NORTHSIDE GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | SOPHIA BLANKS PIERCE Executive Directive 910-488-8477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL026125) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2018-12-03 |