Organization
ABRAXAS HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUSTIN WADE BSHA, LPN, QMHP/QIDP (DIRECTOR OF CLINICAL OPERATIONS)
(804) 714-6120
Entity
Organization
Contact information
Practice address
14201 PLEASANT CREEK PL, SOUTH CHESTERFIELD, VA 23834-6835
(804) 714-6120
(804) 505-2559
Mailing address
14201 PLEASANT CREEK PL, SOUTH CHESTERFIELD, VA 23834-6835
(804) 714-6120
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4387
DBHDS GROUP HOME LICENSE
VA
Enumeration date
07/27/2018
Last updated
08/30/2023
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