| NPI | 1902203235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATONYA WEBB Director 757-333-9264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA OHS 2089) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2014-12-02 |