Provider Demographics
NPI:1376133165
Name:PURPOSE DRIVEN RECOVERY LLC
Entity Type:Organization
Organization Name:PURPOSE DRIVEN RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-376-0177
Mailing Address - Street 1:3157 N RAINBOW BLVD # 346
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4578
Mailing Address - Country:US
Mailing Address - Phone:951-376-0177
Mailing Address - Fax:
Practice Address - Street 1:2785 E DESERT INN RD STE 270
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3693
Practice Address - Country:US
Practice Address - Phone:702-476-2066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health