| NPI | 1770293763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE MICHELLE HARDISON Administrator 252-975-3741 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| 251S00000X Community/Behavioral Health | |
| 311ZA0620X Custodial Care Facility Adult Care Home | |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2023-01-26 |