| NPI | 1770701138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY E PRUETT Executive Director 336-342-4761 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-079-027) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |