| NPI | 1851866479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VAN DAVID WILSON President 757-754-5239 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2018-10-10 |