| NPI | 1174708044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY WAYNE WADSWORTH Register Nurse 804-326-0554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: VA W08002000) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2008-06-13 |