| NPI | 1972021970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALLACE DAVIS President 251-338-1252 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2022-07-21 |