| NPI | 1902928765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN L MCCULLEN Presidential 901-989-1224 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: NC MHL067100) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NC MHL067034) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2012-09-05 |