# HOME BASE WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982592010
- **Authorized official:** MR. RUSSELL F BRADBURY JR. (MANAGER)
- **Authorized official phone:** (804) 690-8613

## Contact information

- **Practice address:** 7511 CONIFER RD, NORTH CHESTERFIELD, VA 23237-1938
- **Practice address phone:** (804) 690-8613
- **Practice address fax:** (804) 918-8959
- **Mailing address:** PO BOX 34527, NORTH CHESTERFIELD, VA 23234-0527
- **Mailing address phone:** (804) 690-8613
- **Mailing address fax:** (804) 918-8959

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/26/2025
- **Last updated:** 06/26/2025