Provider Demographics
NPI:1982651600
Name:LIFEPATH, INC.
Entity Type:Organization
Organization Name:LIFEPATH, INC.
Other - Org Name:COMMUNITY FOUNDATION FOR HUMAN DEVELOPMENT, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-264-5724
Mailing Address - Street 1:3500 HIGH POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7803
Mailing Address - Country:US
Mailing Address - Phone:610-264-5724
Mailing Address - Fax:610-264-2707
Practice Address - Street 1:3500 HIGH POINT BLVD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7803
Practice Address - Country:US
Practice Address - Phone:610-264-5724
Practice Address - Fax:610-264-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 252Y00000X, 252Y00000X, 225100000X, 225X00000X
PA142420261QM0850X
PA545510315P00000X, 315P00000X
PA555140315P00000X
PA629740315P00000X
PA112030320600000X, 320900000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001074Medicaid
LI1334230OtherBLUE CROSS/BLUE SHIELD
DA2402OtherRAILROAD MEDICARE
11500557OtherKEYSTONE MERCY HEALTH PLA
LI1334230OtherBLUE CROSS/BLUE SHIELD