Provider Demographics
| NPI: | 1992547277 |
|---|---|
| Name: | MADAM PATRICIA CHILDREN FOUNDATION |
| Entity type: | Organization |
| Organization Name: | MADAM PATRICIA CHILDREN FOUNDATION |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | HEALTHCARE ADMINISTRATOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | REV LEONARD |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | CHUKWUJIOKE-MBIHA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | CCMA MHA |
| Authorized Official - Phone: | 703-814-6748 |
| Mailing Address - Street 1: | 303 BLUE RIDGE AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | FRONT ROYAL |
| Mailing Address - State: | VA |
| Mailing Address - Zip Code: | 22630-3005 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 703-814-6748 |
| Mailing Address - Fax: | 571-441-0861 |
| Practice Address - Street 1: | 734 W LOCUST ST |
| Practice Address - Street 2: | |
| Practice Address - City: | JOHNSON CITY |
| Practice Address - State: | TN |
| Practice Address - Zip Code: | 37604-6504 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 703-814-6748 |
| Practice Address - Fax: | 571-441-0861 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-06-08 |
| Last Update Date: | 2024-06-08 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 251E00000X | Agencies | Home Health | |
| No | 253Z00000X | Agencies | In Home Supportive Care | |
| No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
| No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | |
| No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
| No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
| No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
| No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |
