| NPI | 1619371655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON BUTCHER Administrator 757-961-6991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2206-01-001) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2014-10-20 |