| NPI | 1356775480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY SHEPHERD Owner 757-292-8244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: VA 1922) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2013-08-26 |