| NPI | 1891219093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE YVETTE OMARI Clinical Director 704-244-9069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2017-07-29 |
| Last Update Date | 2017-07-29 |