| NPI | 1316165749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKIE LYNN PERKINS Lpn 276-963-3554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: VA 0002052423) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |