Provider Demographics
NPI:1558581934
Name:PATRICE'S PLACE, LLC
Entity Type:Organization
Organization Name:PATRICE'S PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CORNELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:804-377-8290
Mailing Address - Street 1:5155 SNEAD RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-6030
Mailing Address - Country:US
Mailing Address - Phone:804-377-8290
Mailing Address - Fax:804-421-8291
Practice Address - Street 1:5201 SNEAD RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-6032
Practice Address - Country:US
Practice Address - Phone:804-377-2960
Practice Address - Fax:804-308-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness