| NPI | 1467989012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCIUS ALFORD Owner 804-271-6725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 1080-01-001) |
| Additional Taxonomies | 251S00000X (Licence: VA 1080-03-001) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2017-05-15 |