| NPI | 1730239062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY DICKERSON Director 919-734-2359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL-096-063) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-08-22 |