| NPI | 1982469268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON MARIE DAVIS Executive Director 704-890-6164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-02-16 |
| Last Update Date | 2024-05-01 |