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General NPI Number Information
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NPI Number | 1801041132
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Entity Type | Organization
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Legal Business Name | VIGILANT MINDZ
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 530 E MAIN ST SUITE 210
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City | RICHMOND
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State | VA
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Zip | 23219-2418
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Country | US
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Telephone | 804-612-2994
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Fax |
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Provider Business Mailing Address
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Address Line | 9709 TARTUFFE DR
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City | RICHMOND
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State | VA
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Zip | 23238-4930
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Country | US
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Telephone | 804-612-2994
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Fax |
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Authorized Official
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Title or Position | C.E,O
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Name | SHAWN LAMONT MINTER
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Credential | B.S.W
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Telephone | 804-306-0163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 1152-02-029
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License Number State | VA
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