| NPI | 1710676622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYISIHA HENRY Administrator 336-405-4946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility Adult Care Home |
| 385H00000X Respite Care | |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2023-05-05 |