| NPI | 1023764578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA MIFFIN Provider 804-939-0092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 251S00000X |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 261QR0800X Clinic/Center, Recovery Care | |
| Enumeration Date | 2022-02-23 |
| Last Update Date | 2024-06-17 |