Healthcare Provider Details

I. General information

NPI: 1114345410
Provider Name (Legal Business Name): GAMBRELL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8014 MIDLOTHIAN TURNPIKE SUITE 202
RICHMOND VA
23235
US

IV. Provider business mailing address

PO BOX 75301
NORTH CHESTERFIELD VA
23236
US

V. Phone/Fax

Practice location:
  • Phone: 804-525-4068
  • Fax: 804-525-4189
Mailing address:
  • Phone: 804-525-4068
  • Fax: 804-525-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NATHAN A WILLIAMS
Title or Position: OWNER
Credential: RN
Phone: 804-943-7358