| NPI | 1306335302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERAH SHANTELE THOMAS Executive Director 757-300-4192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2705) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2018-05-04 |