| NPI | 1952516700 |
|---|---|
| Other Name | MYRTLE GROVE GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | ROBERT T. THACKER, JR. Executive Director 910-762-1189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: NC 3406451) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC 3406451) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2017-07-07 |