| NPI | 1316361736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LASHANUNDA REESE Owner 757-875-2382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2207) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2014-02-05 |