| NPI | 1063799807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN NETTO Administrator 804-869-6155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 1447-01-011) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2022-02-19 |