| NPI | 1750576997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATHAY LORRAINE COLTRANE Owner/Operator 336-299-9757 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-041-620) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2007-09-11 |