Provider Demographics
NPI:1124552013
Name:PURPLE LIGHT TOUCH A NON PROFIT ORGANIZATION
Entity Type:Organization
Organization Name:PURPLE LIGHT TOUCH A NON PROFIT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSO-WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MI LMT
Authorized Official - Phone:817-520-2234
Mailing Address - Street 1:5755 RUFE SNOW DR
Mailing Address - Street 2:SUITE 145
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6055
Mailing Address - Country:US
Mailing Address - Phone:817-520-2234
Mailing Address - Fax:
Practice Address - Street 1:5755 RUFE SNOW DR
Practice Address - Street 2:SUITE 145
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6055
Practice Address - Country:US
Practice Address - Phone:817-520-2234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXME3335302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization