| NPI | 1285774612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA NICOLE GIFFORD Peninsula Regional Director 757-838-8520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 0810003464) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-08-22 |