Provider Demographics
NPI:1518637396
Name:P A T H CENTER LLC
Entity Type:Organization
Organization Name:P A T H CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-886-8695
Mailing Address - Street 1:5545 W 24TH AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4776
Mailing Address - Country:US
Mailing Address - Phone:786-886-8695
Mailing Address - Fax:
Practice Address - Street 1:75 HARNESS LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-7705
Practice Address - Country:US
Practice Address - Phone:786-886-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health