Organization
BOUNDLESS POTENTIAL LLC
Active
Parent organization
BOUNDLESS POTENTIAL LLC
Other names
SISTER'S PLACE GROUP HOME I
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOUNDLESS POTENTIAL LLC
Authorized official
MRS. DEBORAH MALONE RALPH LCSW (DIRECTOR OF CLINICAL SERVICES)
(804) 901-3122
Entity
Organization
Contact information
Practice address
1005 TELEGRAPH STATION LN, GLEN ALLEN, VA 23060-4006
(804) 864-9001
(804) 864-9002
Mailing address
PO BOX 15238, RICHMOND, VA 23227-0638
(804) 261-5577
(804) 261-5574
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
SS-04-09
VA
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
SS-212-07
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00010231159
—
VA
05
—
008907757
—
VA
Enumeration date
02/04/2007
Last updated
08/04/2008
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