| NPI | 1588418529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAZELL BLANDING Owner 804-895-8505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2024-08-12 |