| NPI | 1336000520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHONETTA RUSSELL Authorized Official 757-991-8364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| Enumeration Date | 2025-11-19 |
| Last Update Date | 2025-11-25 |