| NPI | 1851722466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY MOORE Manager 336-350-0296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: NC FCL-001-107) |
| Enumeration Date | 2013-12-06 |
| Last Update Date | 2013-12-06 |