| NPI | 1720790447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAQUAY WADE Director 336-516-6187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2023-02-21 |