| NPI | 1811470552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY M MASSEY Manager 910-220-5785 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC FCL-062-018) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC FCL-062-017) |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC FCL-062-019) | |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2018-09-10 |