Healthcare Provider Details

I. General information

NPI: 1477461994
Provider Name (Legal Business Name): GRAND PURPOSE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 N CENTRE STREET SUITE #2
CUMBERLAND MD
21501
US

IV. Provider business mailing address

1934 W NORTH AVE
BALTIMORE MD
21217-1203
US

V. Phone/Fax

Practice location:
  • Phone: 667-216-1393
  • Fax:
Mailing address:
  • Phone: 667-216-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAQUENTE LAMBERT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 667-216-1393