Provider Demographics
NPI:1669807533
Name:PULSE SPORTZ FOUNDATION INC
Entity type:Organization
Organization Name:PULSE SPORTZ FOUNDATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-496-0501
Mailing Address - Street 1:818 FRIENDLY PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5800
Mailing Address - Country:US
Mailing Address - Phone:704-496-0501
Mailing Address - Fax:
Practice Address - Street 1:818 FRIENDLY PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-5800
Practice Address - Country:US
Practice Address - Phone:704-496-0501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULSESPORTZ FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251E00000XAgenciesHome Health
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No347C00000XTransportation ServicesPrivate Vehicle