Provider Demographics
NPI:1235643693
Name:PATHFINDER ADVOCACY CENTER
Entity Type:Organization
Organization Name:PATHFINDER ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:CARN
Authorized Official - Phone:386-960-7830
Mailing Address - Street 1:4750 E MOODY BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-7711
Mailing Address - Country:US
Mailing Address - Phone:386-960-7830
Mailing Address - Fax:386-960-7833
Practice Address - Street 1:4750 E MOODY BLVD STE 208
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-7711
Practice Address - Country:US
Practice Address - Phone:386-960-7830
Practice Address - Fax:386-960-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health