| NPI | 1861682064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSALINA TEEL Provider 910-592-7451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL-082056) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NC MHL-082-056) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2008-09-09 |