| NPI | 1699957407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARISSA BROADNAX ELLISON Administrator 336-349-2220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: NC FCL-079-004) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2007-12-04 |