Provider Demographics
NPI:1093465098
Name:COMMON PURPOSE
Entity Type:Organization
Organization Name:COMMON PURPOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DUFF
Authorized Official - Suffix:III
Authorized Official - Credentials:SUDCC III
Authorized Official - Phone:530-274-2000
Mailing Address - Street 1:256 BUENA VISTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7239
Mailing Address - Country:US
Mailing Address - Phone:530-274-2000
Mailing Address - Fax:
Practice Address - Street 1:256 BUENA VISTA ST STE 100
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7239
Practice Address - Country:US
Practice Address - Phone:530-274-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health