| NPI | 1063110914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAYESHON DAVIDSON Director Of Services 804-479-1677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2023-06-15 |