| NPI | 1962643411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILBERT NICHOLS ILL Program Director 910-486-8989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: NC FCL 026-033) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2009-03-12 |