| NPI | 1235737560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL BAILEY Provider 804-549-6982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2020-10-09 |