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Organization
ULTIMATE SACRIFICE
Active
Organization
ULTIMATE SACRIFICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASMINE TIARA HOYLE (CEO)
(336) 254-5796
Entity
Organization
Contact information
Practice address
2290 PREMIER PARK LN, WINSTON SALEM, NC 27105-6306
(336) 254-5796
Mailing address
200 GREENSBORO RD, HIGH POINT, NC 27260-3456
(336) 875-4172
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
261QP2300X
Primary Care Clinic/Center
—
—
342000000X
Transportation Network Company
—
—
364SF0001X
Family Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99999
—
NC
Enumeration date
01/05/2021
Last updated
08/16/2023
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