| NPI | 1114491107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL JACKSON Owner 757-536-0080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 385H00000X Respite Care |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2019-01-30 |