| NPI | 1871342618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUANISHA M KING Administrator 252-205-8649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 311ZA0620X Custodial Care Facility Adult Care Home | |
| Enumeration Date | 2024-05-14 |
| Last Update Date | 2024-05-14 |