Provider Demographics
NPI:1740584028
Name:CHAMBERLIN HOUSE NORTH
Entity Type:Organization
Organization Name:CHAMBERLIN HOUSE NORTH
Other - Org Name:VETERAN'S OUTREACH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-261-0019
Mailing Address - Street 1:3822 CHAMBERLAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4110
Mailing Address - Country:US
Mailing Address - Phone:804-261-0019
Mailing Address - Fax:
Practice Address - Street 1:3822 CHAMBERLAYNE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4110
Practice Address - Country:US
Practice Address - Phone:804-261-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAMBERLIN HOUSE NORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-31
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home