| NPI | 1750772919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALTESE FULLER President 336-932-1593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: NC FCL-001-158) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2015-02-10 |