| NPI | 1902189574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWANDA RAY Owner 3364-210-4325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC fcl-001-140) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2011-09-21 |