Healthcare Provider Details

I. General information

NPI: 1275437972
Provider Name (Legal Business Name): PURPOSEFUL LIVING SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 CENTRAL PARK AVE STE 300
VIRGINIA BEACH VA
23462-3271
US

IV. Provider business mailing address

249 CENTRAL PARK AVE STE 300
VIRGINIA BEACH VA
23462-3271
US

V. Phone/Fax

Practice location:
  • Phone: 912-247-9567
  • Fax: 804-884-3702
Mailing address:
  • Phone: 912-247-9567
  • Fax: 804-884-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CATRINA BANKS
Title or Position: OWNER
Credential:
Phone: 912-247-9567