| NPI | 1740473784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARIA MCCOLLUM Owner 252-520-2001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2009-01-21 |