| NPI | 1760897771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANGELO JACKSON Owner/Health Care Coordinator 910-891-2770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385H00000X Respite Care (Licence: NC PE-KX5D1Z7TA) |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care (Licence: NC PE KX5D1Z7TA) |
| 305S00000X Point of Service (Licence: NC PE-KX5D1Z7TA) | |
| 311Z00000X Custodial Care Facility (Licence: NC PE-KX5D1Z7TA) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2015-02-12 |