Basic Information
| Provider Information | |||||||||
| NPI: | 1003329996 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PATH (PEOPLE ACTING TO HELP), INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8220 CASTOR AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191522729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157284600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8220 CASTOR AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191522729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157284600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2017 | ||||||||
| LastUpdateDate: | 11/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | KOCARELI | ||||||||
| AuthorizedOfficialFirstName: | ALICIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SPECIAL PROJECTS COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 2157284696 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 143230 | PA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 100001584 | 05 | PA | MEDICAID |