| NPI | 1821389776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITTIE B FULLER President/Owner 336-227-1613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: NC MHL-001-213) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |