| NPI | 1922842566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTIELOU GILLIAM CEO 757-608-1397 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2024-06-19 |