| NPI | 1912515115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLENE HARRISON Administrator 336-280-1358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2020-07-14 |