1174556401 NPI number — PURPOSE AND PROMISE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174556401 NPI number — PURPOSE AND PROMISE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURPOSE AND PROMISE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174556401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3611 MOUNT HOLLY HUNTERSVILLE RD
Provider Second Line Business Mailing Address:
SUITE 204-123
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28216-8636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-944-5544
Provider Business Mailing Address Fax Number:
704-943-0746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10925 DAVID TAYLOR DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-1040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-944-5544
Provider Business Practice Location Address Fax Number:
704-943-0746
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIGGINS
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
704-944-5544

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  8700457 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8700457 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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