| NPI | 1790299717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA JOHNSON HARRIS Administrator 910-491-3419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2017-11-29 |