Provider Demographics
NPI:1952531428
Name:PURPOSEFUL LIFE
Entity Type:Organization
Organization Name:PURPOSEFUL LIFE
Other - Org Name:PURPOSEFUL LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:TIANA
Authorized Official - Last Name:BURWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-691-0800
Mailing Address - Street 1:4531 ROCKWELL RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-7521
Mailing Address - Country:US
Mailing Address - Phone:919-691-0800
Mailing Address - Fax:
Practice Address - Street 1:4531 ROCKWELL RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-7521
Practice Address - Country:US
Practice Address - Phone:919-691-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health