Healthcare Provider Details

I. General information

NPI: 1346968898
Provider Name (Legal Business Name): PATHWAY2HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GREENLAWN AVE # 100
LANSING MI
48910-2898
US

IV. Provider business mailing address

PO BOX 80453
LANSING MI
48908-0453
US

V. Phone/Fax

Practice location:
  • Phone: 517-291-0587
  • Fax:
Mailing address:
  • Phone: 517-291-0597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID E NELSON
Title or Position: CEO
Credential:
Phone: 517-214-2146