Provider Demographics
NPI:1720708845
Name:PASTA'S PURPOSE LLC
Entity Type:Organization
Organization Name:PASTA'S PURPOSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRSS
Authorized Official - Phone:618-558-5386
Mailing Address - Street 1:219 EASTGATE PLZ
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-1077
Mailing Address - Country:US
Mailing Address - Phone:618-306-9173
Mailing Address - Fax:
Practice Address - Street 1:219 EASTGATE PLZ
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-1077
Practice Address - Country:US
Practice Address - Phone:618-306-9173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health