| NPI | 1194421305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN DAVIS Owner 804-318-0523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2023-01-31 |