Healthcare Provider Details

I. General information

NPI: 1982651600
Provider Name (Legal Business Name): LIFEPATH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 HIGH POINT BLVD
BETHLEHEM PA
18017-7803
US

IV. Provider business mailing address

3500 HIGH POINT BLVD
BETHLEHEM PA
18017-7803
US

V. Phone/Fax

Practice location:
  • Phone: 610-264-5724
  • Fax: 610-264-2707
Mailing address:
  • Phone: 610-264-5724
  • Fax: 610-264-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number142420
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number545510
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number555140
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number629740
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number112030
License Number StatePA
# 9
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number112030
License Number StatePA

VIII. Authorized Official

Name: MR. PAUL H COLEMAN
Title or Position: C.E.O.
Credential:
Phone: 610-264-5724