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General NPI Number Information
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NPI Number | 1134636582
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Entity Type | Organization
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Legal Business Name | LIFE OF PURPOSE NJ, LLC
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 2 EXECUTIVE CAMPUS 2370 NJ-70
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City | CHERRY HILL
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State | NJ
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Zip | 08002-4102
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Country | US
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Telephone | 856-452-3620
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 458
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City | COLLINGSWOOD
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State | NJ
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Zip | 08108-0458
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ANDREW MAGGIORE
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Credential |
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Telephone | 856-452-3620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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