| NPI | 1710326079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY DAVIS- MCDANIEL Director 336-599-5473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL-073-061) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 311ZA0620X Custodial Care Facility Adult Care Home (Licence: NC MHL 073-061) | |
| 385HR2060X Respite Care Respite Care, Mental Retardation and/or Developmental Disabilities | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2019-12-12 |