| NPI | 1083388805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY L MAYFIELD Owner 804-638-3838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2021-08-04 |