Healthcare Provider Details

I. General information

NPI: 1952531428
Provider Name (Legal Business Name): PURPOSEFUL LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2009
Last Update Date: 07/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 ROCKWELL RD
OXFORD NC
27565-7521
US

IV. Provider business mailing address

4531 ROCKWELL RD
OXFORD NC
27565-7521
US

V. Phone/Fax

Practice location:
  • Phone: 919-691-0800
  • Fax:
Mailing address:
  • Phone: 919-691-0800
  • 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: MISS LATASHA TIANA BURWELL
Title or Position: EXECUTIVE DIRECTOR/OWNER
Credential:
Phone: 919-691-0800