Provider Demographics
NPI:1891980868
Name:MY PURPOSE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:MY PURPOSE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVANGELINA
Authorized Official - Middle Name:J
Authorized Official - Last Name:USSIN
Authorized Official - Suffix:
Authorized Official - Credentials:BSW,MSW,RSW
Authorized Official - Phone:985-847-9485
Mailing Address - Street 1:1377 GAUSE BLVD W
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-5765
Mailing Address - Country:US
Mailing Address - Phone:985-847-9485
Mailing Address - Fax:866-200-0061
Practice Address - Street 1:1377 GAUSE BLVD W
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-5765
Practice Address - Country:US
Practice Address - Phone:985-847-9485
Practice Address - Fax:866-200-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1758451251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1758451Medicaid