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Organization
DRIVEN PURPOSE RESIDENTIAL LLC
Active
Organization
DRIVEN PURPOSE RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARQUES ANTWAN JOHNSON B.S. BUS ADM/MGMT (CEO/PRESIDENT)
(919) 802-1577
Entity
Organization
Contact information
Practice address
520 LAURENS WAY, KNIGHTDALE, NC 27545-7633
(919) 266-6915
Mailing address
3210 WALNUT CREEK PKWY APT G, RALEIGH, NC 27606-3693
(919) 802-1577
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/11/2008
Last updated
09/11/2008
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