Provider Demographics
NPI:1407970148
Name:LIFEPATH, INC.
Entity Type:Organization
Organization Name:LIFEPATH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTOCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-773-5555
Mailing Address - Street 1:330 MONTAGUE CITY RD
Mailing Address - Street 2:
Mailing Address - City:TURNERS FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01376-2530
Mailing Address - Country:US
Mailing Address - Phone:413-773-5555
Mailing Address - Fax:413-772-1084
Practice Address - Street 1:330 MONTAGUE CITY RD
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376-2530
Practice Address - Country:US
Practice Address - Phone:413-773-5555
Practice Address - Fax:413-772-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0602868Medicaid