| NPI | 1750614111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODERICK S. HAWTHORNE Chief Administrative Officer 757-558-6914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 1075-14-001) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2009-09-16 |