| NPI | 1932245040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JELORE LITTLE Dir, Contracts & Credentialing 336-545-6338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2019-12-20 |