| NPI | 1104809631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE H MYATT Administrator 757-853-6281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: VA ELO 2005-630) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: VA NH2703) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2020-08-22 |