| NPI | 1992120018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARVARIS J MCCOY CEO 804-381-2501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2079-01-001) |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2014-02-26 |