| NPI | 1962840900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC M. PAGE Operations Manager 336-272-8335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NC MHL-041-752) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC MHL-041-752) |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC MHL0-41-752) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2015-08-28 |