| NPI | 1720835945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAQUANZA JETER Owner/Office Admit 704-697-0561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 251S00000X |
| 251T00000X PACE Provider Organization | |
| 251X00000X | |
| 311Z00000X Custodial Care Facility | |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-05-06 |