Provider Demographics
NPI:1497522304
Name:MINDFUL WELLNESS CARE LLC
Entity Type:Organization
Organization Name:MINDFUL WELLNESS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLSWORTH
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:757-597-3309
Mailing Address - Street 1:4445 CORPORATION LN STE 241
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3676
Mailing Address - Country:US
Mailing Address - Phone:757-597-3309
Mailing Address - Fax:
Practice Address - Street 1:4445 CORPORATION LN STE 241
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3676
Practice Address - Country:US
Practice Address - Phone:757-597-3309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care