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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306461926
- **Authorized official:** CEARIRA S COWAN (ORGANIZER)
- **Authorized official phone:** (980) 925-3476

## Contact information

- **Practice address:** 316 BLACK ROCK SCHOOL RD, CHERRYVILLE, NC 28021-9544
- **Practice address phone:** (980) 924-3476
- **Mailing address:** PO BOX 37, CHERRYVILLE, NC 28021-0037
- **Mailing address phone:** (980) 925-3476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 06/09/2020
- **Last updated:** 04/23/2026