| NPI | 1871786855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONI N JOHNSON Owner 757-224-6852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL 073-045) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-29 |