Provider Demographics
NPI:1902152002
Name:WITH A PURPOSE FAMILY CARE, INC.# 2
Entity Type:Organization
Organization Name:WITH A PURPOSE FAMILY CARE, INC.# 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, QP
Authorized Official - Phone:252-566-9440
Mailing Address - Street 1:6257 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-6805
Mailing Address - Country:US
Mailing Address - Phone:252-566-9440
Mailing Address - Fax:
Practice Address - Street 1:863 BLACK HARPER RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-7042
Practice Address - Country:US
Practice Address - Phone:919-709-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-054-175320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness