Provider Demographics
NPI:1578342721
Name:NEW LIFE PATHWAY LLC
Entity Type:Organization
Organization Name:NEW LIFE PATHWAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:248-417-1008
Mailing Address - Street 1:5000 TOWN CTR STE 1506
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1115
Mailing Address - Country:US
Mailing Address - Phone:248-417-1008
Mailing Address - Fax:
Practice Address - Street 1:23077 GREENFIELD RD STE 156
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3770
Practice Address - Country:US
Practice Address - Phone:248-417-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health