| NPI | 1225041478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN MACCRACKEN Program Director 757-560-2608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2020-08-22 |