| NPI | 1194166074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARESA ROBERTSON HAYNESWORTH Owners 757-550-7272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2016-04-04 |