| NPI | 1972329555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE BALTAZAR Dnp 336-254-8797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385H00000X Respite Care |
| Additional Taxonomies | 251S00000X |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2024-11-27 |
| Last Update Date | 2024-11-27 |