| NPI | 1992015648 |
|---|---|
| Doing Business As | WICKER STREET GROUP NHOME |
| Entity Type | Organization |
| Authorized Contact | EVERETT JONES CEO 336-684-5005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: NC MHL-001-202) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2010-10-15 |