| NPI | 1275639270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOTTIE MAE WALTON Administrator 757-617-9462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 004945646) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2020-08-22 |