| NPI | 1942675624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEROME NWABUEZE Director 336-471-5658 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2015-12-07 |