Provider Demographics
NPI:1508267477
Name:WITH A PURPOSE FAMILY CARE, INC
Entity Type:Organization
Organization Name:WITH A PURPOSE FAMILY CARE, INC
Other - Org Name:WITH A PURPOSE FAMILY CARE #2 WOODY HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR/QUALIFIED PROFESSIONA
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:919-709-6340
Mailing Address - Street 1:6257 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-6805
Mailing Address - Country:US
Mailing Address - Phone:919-709-6340
Mailing Address - Fax:252-566-9440
Practice Address - Street 1:863 BLACK HARPER RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-7042
Practice Address - Country:US
Practice Address - Phone:252-527-5271
Practice Address - Fax:252-566-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-054-175320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness