MEDICARE: PATH TO PURPOSE RECOVERY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1407783848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATH TO PURPOSE RECOVERY, LLC

Provider Business Mailing Address
First Line	:	555 SW 12TH AVE STE 120
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-3595
Country	:	US
Telephone Number	:	954-263-1514
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 SW 12TH AVE STE 120
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-3595
Country	:	US
Telephone Number	:	954-263-1514
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. HOLLY TILLMAN
Credential	:
Telephone Number	:	954-214-0051

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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Directions to “PATH TO PURPOSE RECOVERY, LLC ” Practice Location

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