Provider Demographics
NPI:1114659596
Name:SOUL PURPOSE TRANSITIONAL HOME LLC
Entity Type:Organization
Organization Name:SOUL PURPOSE TRANSITIONAL HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:CADOGAN
Authorized Official - Suffix:II
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-225-4044
Mailing Address - Street 1:PO BOX 8612
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0126
Mailing Address - Country:US
Mailing Address - Phone:480-225-4044
Mailing Address - Fax:
Practice Address - Street 1:30041 W EARLL DR
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-3178
Practice Address - Country:US
Practice Address - Phone:480-225-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-25
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility