| NPI | 1760021695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERNON LAMONT TILLAGE CEO 757-761-3921 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2019-12-23 |