| NPI | 1609344803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAYSUNN MOSES-WALKER Owner 757-402-9765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2018-11-06 |