| NPI | 1912067653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY FLINT GRIMES President 757-238-2038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 65014003) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-22 |