MEDICARE: PATH (PEOPLE ACTING TO HELP), INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility	125170	PA

General Provider Information

NPI Number	:	1427413863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATH (PEOPLE ACTING TO HELP), INC.

Provider Business Mailing Address
First Line	:	8220 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2729
Country	:	US
Telephone Number	:	215-728-4600
Fax Number	:	215-745-6511

Provider Business Practice Location Address
First Line	:	6818 DITMAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-2204
Country	:	US
Telephone Number	:	215-728-4600
Fax Number	:	215-745-6511

Authorized Official
Title or Position	:	HEALTH INFORMATION SYSTEMS DIRECTOR
Name	:	DONNA BOURGEOIS
Credential	:
Telephone Number	:	215-728-4610

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	12/30/2015

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