| NPI | 1902739501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASIAH JACKSON Owner 757-994-2384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2026-06-04 |
| Last Update Date | 2026-06-04 |