| NPI | 1770035750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL GRIMM Director 276-233-2817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2754-08-011) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2016-10-26 |