| NPI | 1922877679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE ALLAN DOVE Owner/Business Director 336-639-8990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2023-12-21 |