| NPI | 1760905178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAQUAY WADE Director 336-516-6187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2020-09-30 |