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General NPI Number Information
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NPI Number | 1982592010
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Entity Type | Organization
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Legal Business Name | HOME BASE WELLNESS
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 7511 CONIFER RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23237-1938
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Country | US
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Telephone | 804-690-8613
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Fax | 804-918-8959
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Provider Business Mailing Address
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Address Line | PO BOX 34527
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-0527
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Country | US
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Telephone | 804-690-8613
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Fax | 804-918-8959
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RUSSELL F BRADBURY JR.
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Credential |
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Telephone | 804-690-8613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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