| NPI | 1952065542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY BLOUNT Credentialing Specialist 252-402-5317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 347C00000X Private Vehicle |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2022-12-20 |