| NPI | 1811584469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY PETERKIN Executive Director 757-779-4493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2020-12-30 |