| NPI | 1942464409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROME DICKENS Executive Director 704-906-1519 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2008-07-14 |