Organization
FRESHPATH HEALTHCARE SERVICES
Active
Parent organization
FRESHPATH
Other names
FreshPath healthcare services, FPM CoLT C
Organization subpart
Yes
Provider details
NPI number
Legal business name
FRESHPATH
Authorized official
DETRO WILKINS (CHIEF EXECUTIVE OFFICER)
(818) 485-9182
Entity
Organization
Contact information
Practice address
11311 MORRISON ST APT 207, NORTH HOLLYWOOD, CA 91601-5366
(818) 485-9182
Mailing address
231 SIERRA DR SE SUITE 4, ALBUQUERQUE, NM 87108
(505) 508-4605
(505) 508-4605
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
—
—
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221-29774
—
NM
Enumeration date
12/02/2011
Last updated
02/21/2023
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