| NPI | 1851739643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY K BRADSHER Adminisrtator Manager 336-226-2575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-001-103) |
| Additional Taxonomies | 251S00000X (Licence: NC MHL-001-103) |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC 6603415) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2018-05-14 |