| NPI | 1982469458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOTHEL WATSON Director 704-490-5511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 253Z00000X In Home Supportive Care | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-02-14 |