| NPI | 1942353172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSALYN JACKSON Owner Program Administrator 704-510-1600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC MHL-060-883) | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: NC mhl-0410713) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2011-02-18 |