Provider Demographics
NPI:1609551043
Name:SANDSTONE CARE VIRGINIA, LLC
Entity Type:Organization
Organization Name:SANDSTONE CARE VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLO
Authorized Official - Middle Name:
Authorized Official - Last Name:LA ROCCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-372-1490
Mailing Address - Street 1:7555 E HAMPDEN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4832
Mailing Address - Country:US
Mailing Address - Phone:720-356-0752
Mailing Address - Fax:
Practice Address - Street 1:5400 SHAWNEE RD STE 101
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2300
Practice Address - Country:US
Practice Address - Phone:888-850-1890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDSTONE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health