| NPI | 1932817517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DALE JACOBS Administrator 910-827-7973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2022-11-11 |
| Last Update Date | 2022-11-11 |