| NPI | 1740307081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI GOUGEON Executive Director 704-536-6661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 251S00000X | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2018-03-20 |