| NPI | 1154774008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY GRIFFIN Program Director 757-286-4352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2016-07-15 |