| NPI | 1710132121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA CAMERON MCBRIDE Director 434-205-1299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-032-464) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2019-01-08 |