| NPI | 1831265180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVIE WIDEMAN Vice President 704-642-0140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2010-09-10 |