Boundless Potential, LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

287-2006 Issued in VA

Legal business name

BOUNDLESS POTENTIAL, LLC

Practice address

10204 Spinning Wheel Way
Richmond, VA 23233

Phone

(804) 864-9001

Fax

(804) 864-9002

NPI assigned

Mar 2, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Deborah Malone Ralph, L.C.S.W.

Title

Director of Clinical Services

Phone

(804) 901-3122

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Sister's Place Group Home II Other name

Tax ID family

Boundless Potential LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Sister'S Place Group Home II

  • Case Manager/Care Coordinator
  • Richmond, VA
  • NPI 1831286806
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Boundless Potential LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Glen Allen, VA
  • NPI 1598803124
  NPPES parent name

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218067200000",
    "number": "1679601280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 15238",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232270638",
            "telephone_number": "804-290-0216",
            "fax_number": "804-290-0427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10204 SPINNING WHEEL WAY",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23233",
            "telephone_number": "804-864-9001",
            "fax_number": "804-864-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNDLESS POTENTIAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2008-08-07",
        "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": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "VA",
            "license": "287-2006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008907757",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008907759",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00010231159",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sister's Place Group Home II",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sylvia Hannah Boudali, CNM
• Doumit S. Bouhaidar, M.D.
• Philip C Boulanger, MD
• Ashley Bouldin
• Camryn Bouldin, RBT
• Iliana Simeonova Bouneva, MD
• Coffee Bourne, CRNA
• Cayla Jablonski Bousaba, RDN
• Nada Bouzaiene, DMD
• Nicole Lynn Bowden, LPTA

• All providers in Richmond, VA
• 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 7, 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.