Provider Demographics
NPI:1275274300
Name:BURGESS BEHAVIORAL HEALTH ALTERNATIVES, LLC
Entity Type:Organization
Organization Name:BURGESS BEHAVIORAL HEALTH ALTERNATIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:THARTA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-787-0408
Mailing Address - Street 1:110 N ROBINSON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4460
Mailing Address - Country:US
Mailing Address - Phone:804-453-3290
Mailing Address - Fax:804-453-3492
Practice Address - Street 1:740 JESSIE DUPONT MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:BURGESS
Practice Address - State:VA
Practice Address - Zip Code:22432
Practice Address - Country:US
Practice Address - Phone:804-453-3290
Practice Address - Fax:804-453-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty