| NPI | 1780058909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BROOKS Ex. Director 980-822-4195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2015-11-26 |
| Last Update Date | 2015-11-26 |