| NPI | 1962754085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY LYNN GRIMES Officer 757-647-1358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: VA 650-14-002) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: VA 65014002) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2012-10-12 |