Provider Demographics
NPI:1427432434
Name:TRADER HEALTHCARE ESSENTIALS
Entity type:Organization
Organization Name:TRADER HEALTHCARE ESSENTIALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:JULIATTE
Authorized Official - Last Name:TRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-564-9878
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23075-0381
Mailing Address - Country:US
Mailing Address - Phone:804-938-3903
Mailing Address - Fax:804-728-2833
Practice Address - Street 1:2130 E TREMONT CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1945
Practice Address - Country:US
Practice Address - Phone:804-564-9878
Practice Address - Fax:804-728-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA32223251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0167527032Medicaid
VA0167511382Medicaid