Organization
HOME BASE WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL F BRADBURY JR. (MANAGER)
(804) 690-8613
Entity
Organization
Contact information
Practice address
7511 CONIFER RD, NORTH CHESTERFIELD, VA 23237-1938
(804) 690-8613
(804) 918-8959
Mailing address
PO BOX 34527, NORTH CHESTERFIELD, VA 23234-0527
(804) 690-8613
(804) 918-8959
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/26/2025
Last updated
06/26/2025
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