MEDICARE: GUIDING YOUNG MINDS 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	320800000X	Mental Illness Community Based Residential Treatment Facility	SS-273-05	VA

General Provider Information

NPI Number	:	1578570768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDING YOUNG MINDS LLC

Provider Business Mailing Address
First Line	:	129 WILKINSON ESTATES DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-2128
Country	:	US
Telephone Number	:	804-264-8214
Fax Number	:	804-264-2554

Provider Business Practice Location Address
First Line	:	129 WILKINSON ESTATES DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-2128
Country	:	US
Telephone Number	:	804-264-8214
Fax Number	:	804-264-2554

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. SILVANUS THROWER
Credential	:
Telephone Number	:	804-647-1792

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/22/2020

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