| NPI | 1841165198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODERICK GIST Owner/Operator 336-287-8789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| Enumeration Date | 2025-10-07 |
| Last Update Date | 2025-10-07 |