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General NPI Number Information
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NPI Number | 1639563893
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Entity Type | Organization
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Legal Business Name | PATHFINDER DEVELOPMENT FOUNDATION INC
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 157 HICKS ST
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City | FAYETTE
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State | MS
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Zip | 39069
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Country | US
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Telephone | 615-717-5474
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2244
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City | FAYETTE
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State | MS
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Zip | 39069-2244
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Country | US
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Telephone | 615-717-5474
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KANAYO CHUDI UGBOAJA
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Credential |
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Telephone | 615-717-5474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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