| NPI | 1366546962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL JEROME BATTLE Program Manager 757-412-8862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 38601001) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2008-06-23 |