| NPI | 1801123716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANORA BROCKMAN Program Administrator 757-923-1937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 347C00000X Private Vehicle |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2009-11-13 |