Healthcare Provider Details

I. General information

NPI: 1154485019
Provider Name (Legal Business Name): PATH (PEOPLE ACTING TO HELP), INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 CASTOR AVE
PHILADELPHIA PA
19134
US

IV. Provider business mailing address

1919 COTTMAN AVE
PHILADELPHIA PA
19111-3816
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-4600
  • Fax:
Mailing address:
  • Phone: 215-728-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number900304
License Number StatePA

VIII. Authorized Official

Name: DR. KAREN L GRAVES
Title or Position: CHIEF OPERATING OFFICER
Credential: PHD
Phone: 215-316-0794