| NPI | 1811142938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL LISETTE GOOLSBY Owner 252-469-3247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-033-061) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2010-12-28 |