MEDICARE: PURPOSE OF LIFE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service

General Provider Information

NPI Number	:	1144519125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPOSE OF LIFE

Provider Business Mailing Address
First Line	:	2601 PALM AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-2239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 PALM AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-2239
Country	:	US
Telephone Number	:	704-345-8825
Fax Number	:	704-900-0787

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. JOANNA BURCH
Credential	:
Telephone Number	:	704-345-8825

Provider Enumeration Date	:	03/30/2011
Last Update Date	:	03/30/2011

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Directions to “PURPOSE OF LIFE ” Practice Location

Language	Start Address	Practice Location

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