| NPI | 1700114816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH EVANS Owner 252-446-8162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-033-067) |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2009-12-01 |