Provider Demographics
NPI:1104556588
Name:PURPOSE DRIVEN SUPPORT SERVICES
Entity type:Organization
Organization Name:PURPOSE DRIVEN SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-359-0700
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0041
Mailing Address - Country:US
Mailing Address - Phone:606-949-1623
Mailing Address - Fax:
Practice Address - Street 1:9575 KY ROUTE 122
Practice Address - Street 2:
Practice Address - City:MCDOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-4164
Practice Address - Country:US
Practice Address - Phone:606-359-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURPOSE DRIVEN SUPPORT SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-16
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management