Provider Demographics
NPI:1639890056
Name:PATH: PERSONALIZED APPROACH TO HEALTH, LLC
Entity Type:Organization
Organization Name:PATH: PERSONALIZED APPROACH TO HEALTH, LLC
Other - Org Name:WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAIMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:860-519-6537
Mailing Address - Street 1:104 ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3728
Mailing Address - Country:US
Mailing Address - Phone:860-519-6537
Mailing Address - Fax:
Practice Address - Street 1:166 ALBANY TPKE STE 6
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2546
Practice Address - Country:US
Practice Address - Phone:860-519-6537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care