| NPI | 1871901074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY COPLIN Official 336-423-8740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2014-07-31 |