| NPI | 1962387506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATWAYA KELLAM Administrator 336-280-9808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-08-11 |