| NPI | 1386440105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY MONIQUE BOONE CEO 757-790-5402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-02-21 |