Provider Demographics
NPI:1134641467
Name:BRAXTON FAMILY SERVICES
Entity Type:Organization
Organization Name:BRAXTON FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-368-3768
Mailing Address - Street 1:11357 NUCKOLS RD # 1276
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5504
Mailing Address - Country:US
Mailing Address - Phone:804-368-3768
Mailing Address - Fax:804-368-1938
Practice Address - Street 1:9463 TRACEY LYNNE CIR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3783
Practice Address - Country:US
Practice Address - Phone:804-368-3768
Practice Address - Fax:804-368-1938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCEL CASE MANAGMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-07
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0234174727Medicaid
VA0240830049Medicaid