| NPI | 1639596273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN LOUISE CARLISLE Cvo 757-403-0429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2037) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2014-03-20 |