Organization
SOUND MIND ADC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLIS HENDERSON (OWNER)
(804) 852-7645
Entity
Organization
Contact information
Practice address
4411 WISTAR RD, HENRICO, VA 23228
(804) 922-7203
Mailing address
4411 WISTAR RD, HENRICO, VA 23228-2640
(804) 922-7203
(804) 262-1576
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
823153086
—
VA
Enumeration date
07/11/2018
Last updated
07/12/2018
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