MEDICARE: SANDSTONE CARE VIRGINIA, 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1508694555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDSTONE CARE VIRGINIA, LLC

Provider Business Mailing Address
First Line	:	7555 E HAMPDEN AVE STE 103
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-4832
Country	:	US
Telephone Number	:	720-372-1490
Fax Number	:

Provider Business Practice Location Address
First Line	:	5040 CORPORATE WOODS DR STE 120A
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4377
Country	:	US
Telephone Number	:	757-244-9083
Fax Number	:

Authorized Official
Title or Position	:	VP PAYOR RELATIONS
Name	:	PAUL GREESPAN
Credential	:
Telephone Number	:	888-228-2384

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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