| NPI | 1952672818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEBRINA PORTER President 757-650-8878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X (Licence: VA 460-03-001) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: VA 460-05-001) |
| 253Z00000X In Home Supportive Care (Licence: VA 460-03-001) | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 460-01-001) | |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2012-01-24 |