Provider Demographics
NPI:1285190355
Name:PLACE OF PURPOSE
Entity Type:Organization
Organization Name:PLACE OF PURPOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDANCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEBANE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-395-0631
Mailing Address - Street 1:150 CHOANOKE INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:WINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27986-9512
Mailing Address - Country:US
Mailing Address - Phone:252-395-0631
Mailing Address - Fax:
Practice Address - Street 1:109 DR MLK JR DR N
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-7612
Practice Address - Country:US
Practice Address - Phone:252-395-0631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health