Provider Demographics
NPI:1487015947
Name:PURPOSEWORKS, LLC
Entity Type:Organization
Organization Name:PURPOSEWORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHIRAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-651-6533
Mailing Address - Street 1:11701 PALM LAKE DR
Mailing Address - Street 2:APT 1610
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-0903
Mailing Address - Country:US
Mailing Address - Phone:904-651-6533
Mailing Address - Fax:
Practice Address - Street 1:11701 PALM LAKE DR
Practice Address - Street 2:APT 1610
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-0903
Practice Address - Country:US
Practice Address - Phone:904-651-6533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL16000039692302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1912388810Medicaid