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General NPI Number Information
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NPI Number | 1255873097
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Entity Type | Organization
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Legal Business Name | PATH OF LIFE OF LAKE WORTH
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Dates
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Enumeration Date | 11/10/2016
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 87 W RUBBER TREE DR
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City | LAKE WORTH
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State | FL
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Zip | 33467-4840
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Country | US
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Telephone | 561-968-8344
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Fax |
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Provider Business Mailing Address
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Address Line | 87 W RUBBER TREE DR
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City | LAKE WORTH
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State | FL
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Zip | 33467-4840
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JESSICA HERNANDEZ
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Credential | R.N.
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Telephone | 305-282-2620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12929
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License Number State | FL
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