| NPI | 1245851088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKAYLAH IYONNA LANG Owner/Administrator 757-287-0499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility |
| 3747P1801X Technician, Personal Care Attendant | |
| 385H00000X Respite Care | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2025-08-28 |