Provider Demographics
NPI:1568050573
Name:ULTIMATE SACRIFICE
Entity Type:Organization
Organization Name:ULTIMATE SACRIFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:TIARA
Authorized Official - Last Name:HOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-254-5796
Mailing Address - Street 1:200 GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-3456
Mailing Address - Country:US
Mailing Address - Phone:336-875-4172
Mailing Address - Fax:
Practice Address - Street 1:2290 PREMIER PARK LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-6306
Practice Address - Country:US
Practice Address - Phone:336-254-5796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No342000000XTransportation ServicesTransportation Network CompanyGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC99999Medicaid