| NPI | 1134638422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LENNIS MARIE WILSON Chief Executive Officer 757-277-2750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2022-07-21 |