| NPI | 1881824282 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE M DAVIS Office Manager 252-442-0578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-033-066) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2009-11-09 |