Born to Be Great II

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

213416003 Issued in VA

Legal business name

BORN TO BE GREAT II

Practice address

3904 Old Hopkins Rd
Richmond, VA 23234-3037

Phone

(804) 218-2088

NPI assigned

Mar 9, 2015

Last updated

Mar 9, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mia Latrese Dejohnette, QMHP

Title

Executive Director

Phone

(804) 218-2088

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1425859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1619360013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19704 THELMA AVE",
            "city": "SOUTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "238032554",
            "telephone_number": "804-218-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3904 OLD HOPKINS RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232343037",
            "telephone_number": "804-218-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BORN TO BE GREAT II",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-09",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "DEJOHNETTE",
        "authorized_official_first_name": "MIA",
        "authorized_official_middle_name": "LATRESE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "804-218-2088",
        "authorized_official_credential": "QMHP"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "VA",
            "license": "213416003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandy Snow Borg, COTA/L
• Janet Borges, L.AC.
• Susan C Borghard, PT
• Shawn M Borich, M.D.
• Danielle Maria Boris
• Joshua W Boron, DO
• Anna Christine Borrelli, LCSW
• Elizabeth Baker Bortell, D.D.S.
• Joseph F Borzelleca Jr., M.D.
• Melanie A Bosco, MA, LPA, LPC, LCMHC

• Case Management Agency in Richmond, VA
• Providers in Richmond, VA by specialty
• Case Management Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; 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.