Provider Demographics
NPI:1689117327
Name:PURPOSELY CHOSEN, INC.
Entity Type:Organization
Organization Name:PURPOSELY CHOSEN, INC.
Other - Org Name:BORN FOR NIA MATERNITY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DRETONA
Authorized Official - Middle Name:TENESE
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-471-0697
Mailing Address - Street 1:1410 3RD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-3482
Mailing Address - Country:US
Mailing Address - Phone:909-471-0697
Mailing Address - Fax:760-302-7607
Practice Address - Street 1:1410 3RD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-3482
Practice Address - Country:US
Practice Address - Phone:909-471-0697
Practice Address - Fax:760-302-7607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health