| NPI | 1609178656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RIZAL L CRUZ Owner 757-408-9760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 1483-01-001) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2010-11-24 |