| NPI | 1063829380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDELL WALLACE Director 757-627-1520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2099-01-001) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2014-07-18 |