| NPI | 1174959423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER FELTS Co Owner 276-235-8188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2015) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2013-09-18 |