| NPI | 1730880873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARNEICE KHALEA DAVIS Owner 704-309-9244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2023-03-15 |
| Last Update Date | 2024-06-20 |