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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	121680	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932379310
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	:	215-728-4597
Fax Number	:

Provider Business Practice Location Address
First Line	:	4224 N FRONT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2714
Country	:	US
Telephone Number	:	215-728-4597
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. JEFF BROWN
Credential	:
Telephone Number	:	215-728-4597

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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