| NPI | 1881886745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMELITA TIBURCIO BIGELOW Program Director 336-222-8616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 132700000X Dietary Manager (Licence: CA 212708) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-08-15 |