Healthcare Provider Details

I. General information

NPI: 1407783848
Provider Name (Legal Business Name): PATH TO PURPOSE RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SW 12TH AVE STE 120
POMPANO BEACH FL
33069-3595
US

IV. Provider business mailing address

555 SW 12TH AVE STE 120
POMPANO BEACH FL
33069-3595
US

V. Phone/Fax

Practice location:
  • Phone: 954-263-1514
  • Fax:
Mailing address:
  • Phone: 954-263-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. HOLLY TILLMAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 954-214-0051