| NPI | 1912176603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACINTA JOHNSON Executive Director 252-438-6700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC MHL-091-002) |
| Additional Taxonomies | 251S00000X |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-091-061) | |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2021-09-10 |