| NPI | 1801064118 |
|---|---|
| Former Legal Business Name | PROVIDENCE PLACE FAMILY CARE HOME |
| Entity Type | Organization |
| Authorized Contact | MOSES OLADAPO OLANREWAJU CEO/Administrator 919-767-9037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL-032-422) |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2008-02-20 |