| NPI | 1346588340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE ALBERT MOORE Owner 804-677-6209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 1536-01-0001) |
| Enumeration Date | 2013-01-25 |
| Last Update Date | 2013-01-25 |