| NPI | 1780755231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY FLINT GRIMES President 757-238-2038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 650-14-001) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 65014001) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VA 51223) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-08-22 |