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General NPI Number Information
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NPI Number | 1144519125
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Entity Type | Organization
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Legal Business Name | PURPOSE OF LIFE
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 2601 PALM AVE
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City | CHARLOTTE
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State | NC
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Zip | 28205-2239
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Country | US
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Telephone | 704-345-8825
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Fax | 704-900-0787
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Provider Business Mailing Address
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Address Line | 2601 PALM AVE
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City | CHARLOTTE
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State | NC
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Zip | 28205-2239
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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 | EXECUTIVE DIRECTOR
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Name | MRS. JOANNA BURCH
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Credential |
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Telephone | 704-345-8825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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