Provider Demographics
NPI:1093088916
Name:WITH A PURPOSE FAMILY CARE, INC.
Entity Type:Organization
Organization Name:WITH A PURPOSE FAMILY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:919-344-5840
Mailing Address - Street 1:6257 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-6805
Mailing Address - Country:US
Mailing Address - Phone:919-344-5840
Mailing Address - Fax:252-566-9440
Practice Address - Street 1:6257 ROBERTS DRIVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:NC
Practice Address - Zip Code:28551-6805
Practice Address - Country:US
Practice Address - Phone:919-344-5840
Practice Address - Fax:252-566-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-054-164320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness