Provider Demographics
NPI:1942718325
Name:A MOTHER'S PURSUIT, LLC
Entity Type:Organization
Organization Name:A MOTHER'S PURSUIT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUDOLPH-WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-758-1362
Mailing Address - Street 1:690 N REILLY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5734
Mailing Address - Country:US
Mailing Address - Phone:910-758-1362
Mailing Address - Fax:
Practice Address - Street 1:511 N REILLY RD STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2440
Practice Address - Country:US
Practice Address - Phone:910-758-1362
Practice Address - Fax:910-758-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health