| NPI | 1780735878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNA WIGGINS GOFORTH Manager 910-488-5634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2008-06-17 |