Provider Demographics
NPI:1790506202
Name:PURE INTENTION SERVICES, LLC
Entity type:Organization
Organization Name:PURE INTENTION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-833-7474
Mailing Address - Street 1:6208 CONSTITUTION DR STE A1
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1585
Mailing Address - Country:US
Mailing Address - Phone:260-833-7474
Mailing Address - Fax:
Practice Address - Street 1:6208 CONSTITUTION DR STE A1
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1585
Practice Address - Country:US
Practice Address - Phone:260-833-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty