| NPI | 1609326750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA EDWARDS Owner 804-276-6713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 679-01-001) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2016-10-12 |