| NPI | 1558773721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA MALLARD GEORGE Director 804-467-2606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2017-03-29 |