| NPI | 1982919668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NASHEBA KEY-ALLRED Contract Administrator 919-783-8898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 251S00000X |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 311Z00000X Custodial Care Facility | |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2021-08-20 |