Provider Demographics
NPI:1093331639
Name:PURPOSE HEALTH LLC
Entity Type:Organization
Organization Name:PURPOSE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-553-0057
Mailing Address - Street 1:101 CHESAPEAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6607
Mailing Address - Country:US
Mailing Address - Phone:410-398-0590
Mailing Address - Fax:443-240-3838
Practice Address - Street 1:101 CHESAPEAKE BLVD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6607
Practice Address - Country:US
Practice Address - Phone:410-398-0590
Practice Address - Fax:443-240-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1043323827Medicaid