| NPI | 1679939169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANINE JOHNSON Executive Director 804-721-6861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 38214035) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2016-01-13 |