Provider Demographics
NPI:1548951080
Name:PATHWAY TO PURPOSE LLC
Entity type:Organization
Organization Name:PATHWAY TO PURPOSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEREETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:850-896-0929
Mailing Address - Street 1:4112 LAMSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-3744
Mailing Address - Country:US
Mailing Address - Phone:813-644-9272
Mailing Address - Fax:
Practice Address - Street 1:4112 LAMSON AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-3744
Practice Address - Country:US
Practice Address - Phone:813-644-9272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health