Healthcare Provider Details

I. General information

NPI: 1609551043
Provider Name (Legal Business Name): SANDSTONE CARE VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 SHAWNEE RD STE 101
ALEXANDRIA VA
22312-2300
US

IV. Provider business mailing address

7555 E HAMPDEN AVE STE 103
DENVER CO
80231-4832
US

V. Phone/Fax

Practice location:
  • Phone: 888-850-1890
  • Fax:
Mailing address:
  • Phone: 720-356-0752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCELLO LA ROCCA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 720-372-1490