Healthcare Provider Details

I. General information

NPI: 1114880770
Provider Name (Legal Business Name): PURE TRAILS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5960 FAIRVIEW RD STE 300
CHARLOTTE NC
28210-0202
US

IV. Provider business mailing address

5960 FAIRVIEW RD STE 300
CHARLOTTE NC
28210-0202
US

V. Phone/Fax

Practice location:
  • Phone: 803-210-8530
  • Fax:
Mailing address:
  • Phone: 803-210-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHASIDY GOINS
Title or Position: CEO
Credential:
Phone: 803-210-8530