| NPI | 1972771152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HANNIBAL CLITUS TUCK Program Director 804-922-1664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2008-02-11 |