Healthcare Provider Details

I. General information

NPI: 1629399969
Provider Name (Legal Business Name): MY GOAL OUR MISSION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 US HIGHWAY 70 E SUITE E
GARNER NC
27529-4040
US

IV. Provider business mailing address

313 US HIGHWAY 70 E SUITE E
GARNER NC
27529-4040
US

V. Phone/Fax

Practice location:
  • Phone: 919-800-0016
  • Fax: 919-800-0016
Mailing address:
  • Phone: 919-800-0016
  • Fax: 919-800-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALLISON MARIE BRISTOW-CHISLEY
Title or Position: CEO
Credential:
Phone: 919-800-0016