Provider Demographics
NPI:1114244480
Name:MY GOAL OUR MISSION, INC
Entity Type:Organization
Organization Name:MY GOAL OUR MISSION, INC
Other - Org Name:MY GOAL OUR MISSION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRISTOW-CHISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-523-8651
Mailing Address - Street 1:313 US HIGHWAY 70 E
Mailing Address - Street 2:SUITE E
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4040
Mailing Address - Country:US
Mailing Address - Phone:919-800-0016
Mailing Address - Fax:919-800-0016
Practice Address - Street 1:313 US HIGHWAY 70 E
Practice Address - Street 2:SUITE E
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4040
Practice Address - Country:US
Practice Address - Phone:919-800-0016
Practice Address - Fax:919-800-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty