| NPI | 1932830932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE LEE GIBSON President 336-274-1269 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2022-06-21 |