Provider Demographics
NPI:1982592010
Name:HOME BASE WELLNESS
Entity type:Organization
Organization Name:HOME BASE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRADBURY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-690-8613
Mailing Address - Street 1:PO BOX 34527
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-0527
Mailing Address - Country:US
Mailing Address - Phone:804-690-8613
Mailing Address - Fax:804-918-8959
Practice Address - Street 1:7511 CONIFER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-1938
Practice Address - Country:US
Practice Address - Phone:804-690-8613
Practice Address - Fax:804-918-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty