| NPI | 1922610088 |
|---|---|
| Former Legal Business Name | EAGLE PHOENIX RESIDENTIAL & BEHAVORIAL HEALTH SERVICES LLC |
| Entity Type | Organization |
| Authorized Contact | MONICA LOTORIA BALLOU CEO/Owner 434-429-2649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2020-08-20 |