| NPI | 1861926867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENAE TYNES Owner 757-316-6719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: VA 125633) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |