| NPI | 1871843904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL DIEDRITCH SICKEROTT Administrator 919-946-1758 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC MHL-092-469) |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2012-09-17 |