Madeleine Village, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL-041-914 Issued in NC

Legal business name

MADELEINE VILLAGE, LLC

Practice address

1476 Rankin Mill Rd
MC Leansville, NC 27301-9504

Phone

(336) 617-3356

Fax

(336) 458-2012

NPI assigned

Jun 20, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Viviane Latestere Lea

Title

Executive Director

Phone

(336) 965-7937

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260230400000",
    "number": "1427285147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 PISGAH CHURCH RD",
            "address_2": "STE 164",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274552590",
            "telephone_number": "336-965-7937",
            "fax_number": "336-458-2012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1476 RANKIN MILL RD",
            "city": "MC LEANSVILLE",
            "state": "NC",
            "postal_code": "273019504",
            "telephone_number": "336-617-3356",
            "fax_number": "336-458-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADELEINE VILLAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-20",
        "last_updated": "2009-12-08",
        "status": "A",
        "authorized_official_last_name": "LEA",
        "authorized_official_first_name": "VIVIANE",
        "authorized_official_middle_name": "LATESTERE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-965-7937",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-041-914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in MC Leansville, NC
• Providers in MC Leansville, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.