| NPI | 1881761427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRELYN WADDELL Ar Manager 919-334-0249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC NA) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TN SO 09985A) |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: KY 50053) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2012-03-19 |