Organization
BOUNDLESS POTENTIAL, LLC
Active
Other names
Sister's Place Group Home II
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH MALONE RALPH L.C.S.W. (DIRECTOR OF CLINICAL SERVICES)
(804) 901-3122
Entity
Organization
Contact information
Practice address
10204 SPINNING WHEEL WAY, RICHMOND, VA 23233
(804) 864-9001
(804) 864-9002
Mailing address
P.O. BOX 15238, RICHMOND, VA 23227-0638
(804) 290-0216
(804) 290-0427
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
287-2006
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00010231159
—
VA
05
—
008907757
—
VA
05
—
008907759
—
VA
Enumeration date
03/02/2007
Last updated
08/07/2008
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