Provider Demographics
NPI:1356167597
Name:LASTING PURPOSE FOUNDATION INC
Entity type:Organization
Organization Name:LASTING PURPOSE FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAKURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TELA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-642-8392
Mailing Address - Street 1:4061 POWDER MILL RD STE 107
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3156
Mailing Address - Country:US
Mailing Address - Phone:240-642-8392
Mailing Address - Fax:
Practice Address - Street 1:4061 POWDER MILL RD STE 107
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3156
Practice Address - Country:US
Practice Address - Phone:240-642-8392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)