Boundless Potential LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

SS-04-09 Issued in VA

Legal business name

BOUNDLESS POTENTIAL LLC

Practice address

1005 Telegraph Station LN
Glen Allen, VA 23060-4006

Phone

(804) 864-9001

Fax

(804) 864-9002

NPI assigned

Feb 4, 2007

Last updated

Aug 4, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

BOUNDLESS POTENTIAL LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Deborah Malone Ralph, LCSWNPI 1497841829

Title

Director of Clinical Services

Phone

(804) 901-3122

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• SISTER'S PLACE GROUP HOME I Other name

Part of

Boundless Potential LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Boundless Potential, LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Richmond, VA
  • NPI 1679601280
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deborah Malone Ralph, L.C.S.W.

  • Specialist
  • Richmond, VA
  • NPI 1497841829
  Authorized official Same address or phone

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

{
    "created_epoch": "1170547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1598803124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15238",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232270638",
            "telephone_number": "804-261-5577",
            "fax_number": "804-261-5574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 TELEGRAPH STATION LN",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230604006",
            "telephone_number": "804-864-9001",
            "fax_number": "804-864-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNDLESS POTENTIAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOUNDLESS POTENTIAL LLC",
        "enumeration_date": "2007-02-04",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "RALPH",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "MALONE",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "804-901-3122",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "VA",
            "license": "SS-212-07",
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "VA",
            "license": "SS-04-09",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00010231159",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008907757",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SISTER'S PLACE GROUP HOME I",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kristi Nicole Bostic
• Bostwick Laboratories, Inc.
• Bostwick Laboratories, Inc.
• Leslie Dana Bottoms, LPC
• Sabrina Bouldin
• William H Bowen, DPT
• Dustin Bowler, DDS
• Angela C. Bowman, LCSW
• Mary Elizabeth Bowman, ACNP-BC
• Emily Boxx, NP

• Emotionally Disturbed Childrens' Residential Treatment Facility in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; 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.