NPIMap

Organization Active NPI

Life of Purpose - Pennsylvania

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fort Washington, PA
National Provider Identifier
1992251326
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
467132 Issued in PA
Legal business name
LIFE OF PURPOSE - PENNSYLVANIA
Practice address
1035 Virginia Dr Ste 120
Fort Washington, PA 19034-3103
Phone
(877) 636-9322
Fax
(866) 417-4309
NPI assigned
Aug 26, 2016
Organization subpart
Yes
Parent organization
LIFE OF PURPOSE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Branden Coluccio
Title
Cfo
Phone
(267) 907-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 467132 PA Primary

Addresses

Primary practice location

1035 Virginia Dr Ste 120
Fort Washington, PA 19034-3103

Mailing address

PO Box 826742
Philadelphia, PA 19182-6742
Phone (877) 636-9322

National Provider Directory

National Provider Directory
Tax ID family
Liberation Way LLC4 organizations share this tax ID, including this one
Part of
Liberation Way LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1992251326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 826742",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191826742",
            "telephone_number": "877-636-9322",
            "fax_number": "866-417-4309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 VIRGINIA DR STE 120",
            "city": "FORT WASHINGTON",
            "state": "PA",
            "postal_code": "190343103",
            "telephone_number": "877-636-9322",
            "fax_number": "866-417-4309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE OF PURPOSE - PENNSYLVANIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFE OF PURPOSE, LLC",
        "enumeration_date": "2016-08-26",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "COLUCCIO",
        "authorized_official_first_name": "BRANDEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "267-907-8000"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "PA",
            "license": "467132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Washington, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; 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.