Active NPI
Freshpath Healthcare Services
- Assisted Living Facility
- North Hollywood, CA
National Provider Identifier
1053689257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- Legal business name
- FRESHPATH HEALTHCARE SERVICES
- Practice address
- 11311 Morrison St Apt 207
North Hollywood, CA 91601-5366 - Phone
- (818) 485-9182
- NPI assigned
- Dec 2, 2011
- Organization subpart
- Yes
- Parent organization
- FRESHPATH
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Detro Wilkins
- Title
- Chief Executive Officer
- Phone
- (818) 485-9182
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | |||
| Assisted Living Facility | 310400000X | Primary |
Addresses
Primary practice location
11311 Morrison St Apt 207
North Hollywood, CA 91601-5366
Mailing address
231 Sierra Dr SE Suite 4
Albuquerque, NM 87108
Phone (505) 508-4605
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 221-29774 | Medicaid | NM |
Other names 2
- FPM CoLT C
- FreshPath healthcare services
National Provider Directory
National Provider Directory- Tax ID family
- Footprints Ministry
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Voluntary or Charitable Agency
- Albuquerque, NM
- NPI 1043507320
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322784000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1676937600000",
"number": "1053689257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "231 SIERRA DR SE SUITE 4",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87108",
"telephone_number": "505-508-4605",
"fax_number": "505-508-4605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11311 MORRISON ST APT 207",
"city": "NORTH HOLLYWOOD",
"state": "CA",
"postal_code": "916015366",
"telephone_number": "818-485-9182"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRESHPATH HEALTHCARE SERVICES",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FRESHPATH",
"enumeration_date": "2011-12-02",
"last_updated": "2023-02-21",
"certification_date": "2023-02-21",
"status": "A",
"authorized_official_last_name": "WILKINS",
"authorized_official_first_name": "DETRO",
"authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "818-485-9182"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": false
},
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "221-29774",
"state": "NM"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "FPM CoLT C",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "FreshPath healthcare services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in North Hollywood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.