| NPI | 1487730008 |
|---|---|
| Doing Business As | 180 BOYS ADOLESCENT GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | MARVIN VAN ROANE President/CEO 804-349-6382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: VA SS-280-06) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2020-08-22 |