| NPI | 1154448496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH FISHER C.A.O 804-228-3729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA S8-04-20) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |