| NPI | 1770988123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY EDWARD LINDSTOM CEO 804-382-3741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 0002369) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2014-10-28 |