Provider Demographics
NPI:1952897167
Name:LIFE'S PURPOSE HEALTH AGENCY
Entity Type:Organization
Organization Name:LIFE'S PURPOSE HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-910-5830
Mailing Address - Street 1:3553 N SHARON AMITY RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-8992
Mailing Address - Country:US
Mailing Address - Phone:704-910-5830
Mailing Address - Fax:704-228-3001
Practice Address - Street 1:3553 N SHARON AMITY RD STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-8992
Practice Address - Country:US
Practice Address - Phone:704-910-5830
Practice Address - Fax:704-228-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC384554Medicaid