Driven Purpose Residential LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

DRIVEN PURPOSE RESIDENTIAL LLC

Practice address

520 Laurens Way
Knightdale, NC 27545-7633

Phone

(919) 266-6915

NPI assigned

Sep 11, 2008

Last updated

Sep 11, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Marques Antwan Johnson, B.S. BUS ADM/MGMT

Title

Ceo/President

Phone

(919) 802-1577

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1942459284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 WALNUT CREEK PKWY APT G",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276063693",
            "telephone_number": "919-802-1577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 LAURENS WAY",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275457633",
            "telephone_number": "919-266-6915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRIVEN PURPOSE RESIDENTIAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-11",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARQUES",
        "authorized_official_middle_name": "ANTWAN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "919-802-1577",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "B.S. BUS ADM/MGMT"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Knightdale, NC
• Providers in Knightdale, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.