Provider Demographics
NPI:1073937785
Name:PURPLE CACTUS, LLC
Entity Type:Organization
Organization Name:PURPLE CACTUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-625-0808
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:INTERCESSION CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33848-0026
Mailing Address - Country:US
Mailing Address - Phone:407-625-0808
Mailing Address - Fax:
Practice Address - Street 1:2515 OLD KENT CIRCLE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758
Practice Address - Country:US
Practice Address - Phone:407-625-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty