| NPI | 1316492028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHIDI EKWUEME Program Manager 757-560-6073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 2351) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: VA 2351) |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2351) | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2017-10-30 |