| NPI | 1073120242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANETTE WHITEHEAD Administrator 757-348-3168 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2020-09-30 |