Provider Demographics
NPI:1821490566
Name:COMPANIONS
Entity Type:Organization
Organization Name:COMPANIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-273-0579
Mailing Address - Street 1:9300 GILDENFIELD CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-5621
Mailing Address - Country:US
Mailing Address - Phone:804-273-0579
Mailing Address - Fax:804-527-5325
Practice Address - Street 1:9300 GILDENFIELD CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-5621
Practice Address - Country:US
Practice Address - Phone:804-273-0579
Practice Address - Fax:804-527-5325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB09159000320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA231151738Medicaid