Healthcare Provider Details

I. General information

NPI: 1508627050
Provider Name (Legal Business Name): CAREBRIDGE AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10221 KRAUSE RD UNIT 2401
CHESTERFIELD VA
23832-1297
US

IV. Provider business mailing address

PO BOX 2401
CHESTERFIELD VA
23832-9114
US

V. Phone/Fax

Practice location:
  • Phone: 804-723-6636
  • Fax:
Mailing address:
  • Phone: 804-723-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: CANDICE CARRINGTON
Title or Position: OWNER
Credential: RN
Phone: 804-723-6636