| NPI | 1093141517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAKIA HAYES-CONWAY Administrative Director 804-833-0873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 1821-01-001) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2013-09-16 |