MEDICARE: PATHWAY TO PURPOSE LLC

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	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1548951080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHWAY TO PURPOSE LLC

Provider Business Mailing Address
First Line	:	4112 LAMSON AVE
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-3744
Country	:	US
Telephone Number	:	813-644-9272
Fax Number	:

Provider Business Practice Location Address
First Line	:	4112 LAMSON AVE
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-3744
Country	:	US
Telephone Number	:	813-644-9272
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHEREETA BLACK
Credential	:	MS
Telephone Number	:	850-896-0929

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	05/16/2023

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Directions to “PATHWAY TO PURPOSE LLC ” Practice Location

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