| NPI | 1659839793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE CHERISE THOMAS Administrator 804-615-4542 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2019-03-07 |