MEDICARE: TELETHRIVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1972366896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELETHRIVE

Provider Business Mailing Address
First Line	:	PO BOX 1330
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-9103
Country	:	US
Telephone Number	:	804-441-3647
Fax Number	:

Provider Business Practice Location Address
First Line	:	15871 CITY VIEW DR STE 202
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-7304
Country	:	US
Telephone Number	:	804-464-5724
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRANDON HUDSON
Credential	:
Telephone Number	:	804-441-3647

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

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Directions to “TELETHRIVE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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