| NPI | 1376872465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEWIS KEVIN MOORE Co Owner 757-641-1061 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 1140) |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2010-05-13 |