| NPI | 1790418119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMITRA NICOLE MICKEY CEO 757-292-3687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult | |
| 251J00000X Nursing Care | |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 251S00000X | |
| Enumeration Date | 2022-07-04 |
| Last Update Date | 2022-07-04 |