Provider Demographics
NPI:1982424263
Name:LIFEPATH CENTER
Entity type:Organization
Organization Name:LIFEPATH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALEIADIH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:951-207-8224
Mailing Address - Street 1:3769 TIBBETTS ST STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2638
Mailing Address - Country:US
Mailing Address - Phone:951-405-8131
Mailing Address - Fax:
Practice Address - Street 1:3769 TIBBETTS ST STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2638
Practice Address - Country:US
Practice Address - Phone:951-405-8131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health