Organization · NPI-2

Purposely Chosen, INC.

Residential Treatment Facility, Emotionally Disturbed Children · Riverside, CA

NPI number1689117327

StatusActive

Last updated in NPPESAug 11, 2021

Details

NPI: 1689117327
Entity type: Organization (NPI-2)
Legal business name: Purposely Chosen, INC.
Organization subpart: No
Enumeration date: Nov 29, 2016
Certification date: Aug 11, 2021
Last updated: Aug 11, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	–	–	Yes
251B00000X	Case Management	–	–
251J00000X	Nursing Care	–	–
251K00000X	Public Health or Welfare	–	–
251S00000X	Community/Behavioral Health	–	–

Other names

Born For Nia Maternity Home (Doing Business As)

Practice location

1410 3rd St
Suite 2
Riverside, CA 92507-3482

Phone 909-471-0697 · Fax 760-302-7607

Mailing address

1410 3rd St
Suite 2
Riverside, CA 92507-3482

Phone 909-471-0697 · Fax 760-302-7607

Authorized official

Dretona Tenese Maddox
Executive Director
9094710697

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.