Provider Demographics
NPI:1558870295
Name:BROWN-CAMPBELL, LISA M (CNA/MED TECH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BROWN-CAMPBELL
Suffix:
Gender:F
Credentials:CNA/MED TECH
Other - Prefix:
Other - First Name:A PLACE CALLED HOME
Other - Middle Name:
Other - Last Name:ASSISTED LIVING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:13513 PRINDELL CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7112
Mailing Address - Country:US
Mailing Address - Phone:804-748-3637
Mailing Address - Fax:866-512-7883
Practice Address - Street 1:906 LAUREL RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-1445
Practice Address - Country:US
Practice Address - Phone:804-732-0396
Practice Address - Fax:804-732-1459
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility