| NPI | 1982455820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROOSEVELT OWENS Owner 757-694-1669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-03-28 |
| Last Update Date | 2024-03-28 |