| NPI | 1073796694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD A. WALLACE Executive Director 804-307-6908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: VA 911-01001) |
| Additional Taxonomies | 310500000X Intermediate Care Facility, Mental Illness (Licence: VA 911-01001) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2007-12-06 |