| NPI | 1174759047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES CALVIN WILLIS Program Director 757-739-1703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: NC 3810) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: VA 0701003547) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2009-06-05 |