Healthcare Provider Details

I. General information

NPI: 1336043686
Provider Name (Legal Business Name): PURPOSE DRIVEN LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 GLADSTONE ST
DETROIT MI
48202-1709
US

IV. Provider business mailing address

811 GLADSTONE ST
DETROIT MI
48202-1709
US

V. Phone/Fax

Practice location:
  • Phone: 313-677-6338
  • Fax:
Mailing address:
  • Phone: 313-677-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: KENYATTA CROSBY
Title or Position: ADMINISTRATOR
Credential:
Phone: 586-354-6074