| NPI | 1902263106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC PAGE Operations Manager 336-272-8335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-041-1122) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 251S00000X (Licence: NC MHL-041-1122) | |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-03-08 |