Healthcare Provider Details

I. General information

NPI: 1154232981
Provider Name (Legal Business Name): PURPOSEFUL LIVING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 RALEIGH ST STE B
OXFORD NC
27565-3738
US

IV. Provider business mailing address

614 RALEIGH ST
OXFORD NC
27565-3738
US

V. Phone/Fax

Practice location:
  • Phone: 919-939-8328
  • Fax:
Mailing address:
  • Phone:
  • 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: KEYERRA WADE
Title or Position: OWNER
Credential:
Phone: 919-939-8328