| NPI | 1982169751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVENDRA PATEL Owner 757-675-9069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2019-02-06 |