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General NPI Number Information
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NPI Number | 1518637396
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Entity Type | Organization
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Legal Business Name | P A T H CENTER LLC
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 75 HARNESS LN
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City | KISSIMMEE
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State | FL
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Zip | 34743-7705
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Country | US
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Telephone | 786-886-8695
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Fax |
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Provider Business Mailing Address
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Address Line | 5545 W 24TH AVE APT 206
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City | HIALEAH
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State | FL
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Zip | 33016-4776
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Country | US
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Telephone | 786-886-8695
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALTER L RICARDO
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Credential |
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Telephone | 786-886-8695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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