Healthcare Provider Details

I. General information

NPI: 1952681751
Provider Name (Legal Business Name): PATHWAYS TO SELF DETERMINATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 N OLD WOODWARD AVE BUILDING A, SUITE 5
BIRMINGHAM MI
48009-5305
US

IV. Provider business mailing address

237 N OLD WOODWARD AVE BUILDING A, SUITE 5
BIRMINGHAM MI
48009-5305
US

V. Phone/Fax

Practice location:
  • Phone: 248-723-7152
  • Fax: 248-723-7162
Mailing address:
  • Phone: 248-723-7152
  • Fax: 248-723-7162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. JANET A. PATTERSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 248-723-7152