# MADELEINE VILLAGE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427285147
- **Authorized official:** MRS. VIVIANE LATESTERE LEA (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (336) 965-7937

## Contact information

- **Practice address:** 1476 RANKIN MILL RD, MC LEANSVILLE, NC 27301-9504
- **Practice address phone:** (336) 617-3356
- **Practice address fax:** (336) 458-2012
- **Mailing address:** 415 PISGAH CHURCH RD, STE 164, GREENSBORO, NC 27455-2590
- **Mailing address phone:** (336) 965-7937
- **Mailing address fax:** (336) 458-2012

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-041-914 | NC | Yes |

## Other

- **Enumeration date:** 06/20/2009
- **Last updated:** 12/08/2009