| NPI | 1659764629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERNON TYRONE JOHNSON CEO 757-439-0853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 142101001) |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2015-03-13 |