| NPI | 1659454858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN LAVERNE WALTON Administrator 757-484-4009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-08-22 |