| NPI | 1770607384 |
|---|---|
| Doing Business As | VIRGINIA DARE HOME C |
| Entity Type | Organization |
| Authorized Contact | PHYLLIS MAXINE WARD Administrator 252-238-2622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NC MHL040016) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |