| NPI | 1831256858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE TRIPP Owner 336-638-3494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-041-627) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-041-676) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-08-22 |