| NPI | 1730319773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICE CLARK Owner 252-446-6612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL064102) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2009-07-24 |