| NPI | 1205858461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRON NICHOLS Program Director 757-635-6573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 699-01-001) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2024-07-02 |