| NPI | 1275872400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN LEE CARLISLE Owner/CEO 757-403-0429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: VA 2037) |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2013-02-07 |