| NPI | 1205612033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY COPELAND CFO 757-201-9832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2023-09-07 |