| NPI | 1144613092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BURKE CAO 757-262-7577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 1033) |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2015-03-16 |