MEDICARE: BUILD AND BLOSSOM BEHAVIORAL HEALTH LLC

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	:	1235014325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILD AND BLOSSOM BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	10049 MIDLOTHIAN TPKE STE F
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4859
Country	:	US
Telephone Number	:	276-444-4199
Fax Number	:	276-209-6273

Provider Business Practice Location Address
First Line	:	10049 MIDLOTHIAN TPKE STE F
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4859
Country	:	US
Telephone Number	:	276-444-4199
Fax Number	:	276-209-6273

Authorized Official
Title or Position	:	OWNER
Name	:	NIESHA ROBINSON
Credential	:
Telephone Number	:	276-208-6273

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	08/07/2025

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