Healthcare Provider Details

I. General information

NPI: 1942654553
Provider Name (Legal Business Name): PATHFINDER ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2487 S VOLUSIA AVE SUITE 109
ORANGE CITY FL
32763-7607
US

IV. Provider business mailing address

2487 S VOLUSIA AVE SUITE 109
ORANGE CITY FL
32763-7607
US

V. Phone/Fax

Practice location:
  • Phone: 386-960-7830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA LATIMER
Title or Position: CEO
Credential:
Phone: 386-960-7830