Healthcare Provider Details

I. General information

NPI: 1639563893
Provider Name (Legal Business Name): PATHFINDER DEVELOPMENT FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 HICKS ST
FAYETTE MS
39069
US

IV. Provider business mailing address

PO BOX 2244
FAYETTE MS
39069-2244
US

V. Phone/Fax

Practice location:
  • Phone: 615-717-5474
  • Fax:
Mailing address:
  • Phone: 615-717-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KANAYO CHUDI UGBOAJA
Title or Position: CEO
Credential:
Phone: 615-717-5474