Provider Demographics
NPI:1467735324
Name:HEALTH BRIGADE
Entity Type:Organization
Organization Name:HEALTH BRIGADE
Other - Org Name:FAN FREE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEGATO
Authorized Official - Suffix:
Authorized Official - Credentials:MPS, MSW
Authorized Official - Phone:804-358-6343
Mailing Address - Street 1:1010 N. THOMPSON STREET
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4925
Mailing Address - Country:US
Mailing Address - Phone:804-358-6343
Mailing Address - Fax:804-354-0702
Practice Address - Street 1:1010 N. THOMPSON ST.
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4925
Practice Address - Country:US
Practice Address - Phone:804-358-6343
Practice Address - Fax:804-354-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101042501261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty