| 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 | 251S00000X Community/Behavioral Health |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2025-03-27 |