Provider Demographics
NPI:1043612104
Name:SIMPLE INTERVENTION, LLC
Entity Type:Organization
Organization Name:SIMPLE INTERVENTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:804-621-4034
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9103
Mailing Address - Country:US
Mailing Address - Phone:804-621-4034
Mailing Address - Fax:804-200-5413
Practice Address - Street 1:9850 LORI RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6758
Practice Address - Country:US
Practice Address - Phone:804-621-4034
Practice Address - Fax:804-621-4091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUDSON ENTERPRISE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-20
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2548251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health