1508267477 NPI number — WITH A PURPOSE FAMILY CARE, INC

Table of content: MISS APRYL STOLDT C.M.T. (NPI 1396974275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508267477 NPI number — WITH A PURPOSE FAMILY CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WITH A PURPOSE FAMILY CARE, 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:
6
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:
1508267477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6257 ROBERTS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28551-6805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-709-6340
Provider Business Mailing Address Fax Number:
252-566-9440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
863 BLACK HARPER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28504-7042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-527-5271
Provider Business Practice Location Address Fax Number:
252-566-9440
Provider Enumeration Date:
09/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
ADMINISTRATOR/QUALIFIED PROFESSIONA
Authorized Official Telephone Number:
919-709-6340

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  MHL-054-175 , 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)





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