| NPI | 1760952592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN TAYLOR STORES Owner/Program Director 757-672-8237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2018-12-05 |