| NPI | 1821234337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NARCISA BLANCAFLOR DELA CRUZ Residential Director 757-650-0673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: VA 1117) |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2009-01-05 |