Healthcare Provider Details

I. General information

NPI: 1548951080
Provider Name (Legal Business Name): PATHWAY TO PURPOSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 LAMSON AVE
SPRING HILL FL
34608-3744
US

IV. Provider business mailing address

4112 LAMSON AVE
SPRING HILL FL
34608-3744
US

V. Phone/Fax

Practice location:
  • Phone: 813-644-9272
  • Fax:
Mailing address:
  • Phone: 813-644-9272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHEREETA BLACK
Title or Position: OWNER
Credential: MS
Phone: 850-896-0929