| NPI | 1891838116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL DUDLEY Administrator 336-549-1081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC MHL-001-074) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-001-074) |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-001-074) | |
| 385H00000X Respite Care (Licence: NC MHL-001-074) | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL-001-074) | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: NC MHL-001-074) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2008-06-16 |