| NPI | 1891040333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY LEE LACKEY Director 919-773-2706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2017-07-07 |