Provider Demographics
NPI:1508197328
Name:GODS DIVINE PURPOSE
Entity Type:Organization
Organization Name:GODS DIVINE PURPOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-420-7893
Mailing Address - Street 1:3437 SHEPHERD RD TRLR 42
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-7553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3437 SHEPHERD RD TRLR 42
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-7553
Practice Address - Country:US
Practice Address - Phone:336-420-7893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-001190320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities