| NPI | 1306265715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ROBINSON LEE Owner/Administrator 757-234-1418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2014-04-14 |