Provider Demographics
NPI:1811539083
Name:PURPOSEFUL DNA
Entity type:Organization
Organization Name:PURPOSEFUL DNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARD-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:757-201-8083
Mailing Address - Street 1:600 GETTY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2161
Mailing Address - Country:US
Mailing Address - Phone:757-201-8083
Mailing Address - Fax:
Practice Address - Street 1:600 GETTY AVE STE 112
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2161
Practice Address - Country:US
Practice Address - Phone:757-201-8083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251300000XAgenciesLocal Education Agency (LEA)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities