| NPI | 1780008177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACOLD LATRESE PRIDGEN Supervisor 910-789-1937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2014-02-06 |