| NPI | 1912216334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELRICK DEVON KING Owner 757-270-5585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2010-10-04 |