| NPI | 1447494042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON BERNARD RUSSELL Executive Officer 757-647-2407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 1078-014-001) |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2009-04-27 |