| NPI | 1780019513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE DAWNETTE BURTON Owner 336-514-7344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC 263278) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2013-09-15 |