| NPI | 1902988702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERWIN LAMONT HICKMAN CEO 804-527-0992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 792001001) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2020-08-22 |