| NPI | 1134839798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON KEELS Vice President 757-572-1516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2023-12-12 |