| NPI | 1861607616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOYCE ANN CARR Director 910-214-5379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MHL-082-062) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: NC MHL-082-062) |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-082-062) | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |