| NPI | 1962536672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN DAVIS Administrator 252-257-3513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC HAL-093001) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC FCL-093001) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-08-22 |