| NPI | 1942369079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIO JERMAINE JACKSON Director 252-205-0381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC 007052) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |