| NPI | 1770782120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE L GIBSON President 336-274-1269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2024-05-29 |