Healthcare Provider Details

I. General information

NPI: 1194873174
Provider Name (Legal Business Name): PATH (PEOPLE ACTING TO HELP), INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 ROOSEVELT BLVD BLDG B
PHILADELPHIA PA
19124-2343
US

IV. Provider business mailing address

8220 CASTOR AVE
PHILADELPHIA PA
19152-2729
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-4597
  • Fax:
Mailing address:
  • Phone: 215-728-4597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number105100
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF BROWN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 215-728-4597