Healthcare Provider Details

I. General information

NPI: 1689117327
Provider Name (Legal Business Name): PURPOSELY CHOSEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 3RD ST SUITE 2
RIVERSIDE CA
92507-3482
US

IV. Provider business mailing address

1410 3RD ST SUITE 2
RIVERSIDE CA
92507-3482
US

V. Phone/Fax

Practice location:
  • Phone: 909-471-0697
  • Fax: 760-302-7607
Mailing address:
  • Phone: 909-471-0697
  • Fax: 760-302-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DRETONA TENESE MADDOX
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 909-471-0697