Provider Demographics
NPI:1861679664
Name:ANOTHER PATH, PLC
Entity Type:Organization
Organization Name:ANOTHER PATH, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-942-6670
Mailing Address - Street 1:12100 S BENZONIA TRL
Mailing Address - Street 2:
Mailing Address - City:EMPIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49630-8503
Mailing Address - Country:US
Mailing Address - Phone:231-941-6670
Mailing Address - Fax:231-326-3026
Practice Address - Street 1:12100 S BENZONIA TRL
Practice Address - Street 2:
Practice Address - City:EMPIRE
Practice Address - State:MI
Practice Address - Zip Code:49630
Practice Address - Country:US
Practice Address - Phone:231-941-6670
Practice Address - Fax:231-326-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038246251S00000X
MI6801035572251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health