| NPI | 1083743942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL FIDGEON COO 540-710-6085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: VA 15802029) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2020-08-22 |