Provider Demographics
NPI:1821740259
Name:HOME OF THE BRAVE, VETERANS TRANSITIONAL HOUSING
Entity Type:Organization
Organization Name:HOME OF THE BRAVE, VETERANS TRANSITIONAL HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-559-4522
Mailing Address - Street 1:106 FOX LN
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-9481
Mailing Address - Country:US
Mailing Address - Phone:757-559-4522
Mailing Address - Fax:
Practice Address - Street 1:106 FOX LN
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-9481
Practice Address - Country:US
Practice Address - Phone:757-559-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No251B00000XAgenciesCase Management