MEDICARE: THELMARELOUS HEALTHCARE AGENCY 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1497108567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THELMARELOUS HEALTHCARE AGENCY LLC

Provider Business Mailing Address
First Line	:	PO BOX 25083
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23260-5083
Country	:	US
Telephone Number	:	804-836-8818
Fax Number	:	804-308-3304

Provider Business Practice Location Address
First Line	:	7122 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1542
Country	:	US
Telephone Number	:	804-836-8818
Fax Number	:	804-308-3304

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. EVERLY THELME WALTON
Credential	:	PH,D
Telephone Number	:	804-836-8818

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	10/18/2016

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