Organization
MADELEINE VILLAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIVIANE LATESTERE LEA (EXECUTIVE DIRECTOR)
(336) 965-7937
Entity
Organization
Contact information
Practice address
1476 RANKIN MILL RD, MC LEANSVILLE, NC 27301-9504
(336) 617-3356
(336) 458-2012
Mailing address
415 PISGAH CHURCH RD, STE 164, GREENSBORO, NC 27455-2590
(336) 965-7937
(336) 458-2012
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-041-914
NC
Other
Enumeration date
06/20/2009
Last updated
12/08/2009
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