| NPI | 1740601079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE MELISSA TABB CEO/Owner 757-513-9195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2057) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-01-06 |