| NPI | 1841336062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA RENEE ROUSE Administrator 336-427-0609 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL-079-004) |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC MHL-079-047) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2015-09-10 |