| NPI | 1588937379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IDA M NELSON Co Owner 804-363-8964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: VA 0710102443) |
| Additional Taxonomies | 251B00000X Case Management (Licence: VA 0710102443) |
| 251S00000X Community/Behavioral Health (Licence: VA 0710102443) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710102443) | |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-11-06 |