Provider Demographics
NPI:1710510409
Name:SOUL PURPOSE HOME CARE, LLC
Entity Type:Organization
Organization Name:SOUL PURPOSE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTGERINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-871-0871
Mailing Address - Street 1:1650 BARLOW ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-4721
Mailing Address - Country:US
Mailing Address - Phone:231-871-0871
Mailing Address - Fax:231-241-1118
Practice Address - Street 1:1650 BARLOW ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4721
Practice Address - Country:US
Practice Address - Phone:231-871-0871
Practice Address - Fax:231-241-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health