Provider Demographics
NPI:1538625975
Name:PURPOSEFUL RESIDENTIAL CARE, LLC
Entity type:Organization
Organization Name:PURPOSEFUL RESIDENTIAL CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ADONICA
Authorized Official - Middle Name:NELL
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-378-3764
Mailing Address - Street 1:5701 TRUXTUN AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0402
Mailing Address - Country:US
Mailing Address - Phone:661-378-3764
Mailing Address - Fax:661-344-4266
Practice Address - Street 1:1308 ERIE ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-3974
Practice Address - Country:US
Practice Address - Phone:661-412-4541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURPOSEFUL RESIDENTIAL CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-11
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care