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General NPI Number Information
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NPI Number | 1275486912
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Entity Type | Organization
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Legal Business Name | PURE LOVE SUPPORTED LIVING LLC
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 3415 OAK LAWN DR
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City | CLARKSVILLE
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State | TN
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Zip | 37042-5899
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Country | US
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Telephone | 931-551-2712
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Fax | 931-274-0929
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Provider Business Mailing Address
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Address Line | 1725 WILMA RUDOLPH BLVD STE J
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City | CLARKSVILLE
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State | TN
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Zip | 37040-7079
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Country | US
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Telephone | 931-551-2712
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Fax | 931-274-0929
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Authorized Official
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Title or Position | OWNER
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Name | LAQUVIA SHIEKA GARRETT
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Credential | MBA
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Telephone | 931-561-4204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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