| NPI | 1356115950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NITA VIANN RANDOLPH DAVISON CEO 804-605-9845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2023-11-14 |