Healthcare Provider Details

I. General information

NPI: 1740584028
Provider Name (Legal Business Name): CHAMBERLIN HOUSE NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2010
Last Update Date: 12/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3822 CHAMBERLAYNE AVE
RICHMOND VA
23227-4110
US

IV. Provider business mailing address

3822 CHAMBERLAYNE AVE
RICHMOND VA
23227-4110
US

V. Phone/Fax

Practice location:
  • Phone: 804-261-0019
  • Fax:
Mailing address:
  • Phone: 804-261-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: VERONICA WILLIAMS
Title or Position: OWNER
Credential:
Phone: 804-261-0019